Surgical system comprising a surgical tool and a surgical hub

ABSTRACT

A surgical system for use in a surgical theater is disclosed. The surgical system comprises a surgical tool and a surgical hub. The surgical tool comprises a motor, a motor controller in signal communication with the motor, and an end effector configured to perform an end effector function. The end effector is operably responsive to the motor. The surgical hub is in signal communication with the motor controller. The surgical hub is configured to detect a contextual cue within the surgical theater. The motor controller is configured to adjust an operating parameter of the motor based on the contextual cue detected by the surgical hub.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional PatentApplication Ser. No. 62/750,555, entitled SURGICAL CLIP APPLIER, filedOct. 25, 2018, the disclosure of which is incorporated by referenceherein in its entirety. This application claims the benefit of U.S.Provisional Patent Application Ser. No. 62/659,900, entitled METHOD OFHUB COMMUNICATION, filed Apr. 19, 2018, the disclosure of which isincorporated by reference herein in its entirety. This applicationclaims the benefit of U.S. Provisional Patent Application Ser. No.62/665,128, entitled MODULAR SURGICAL INSTRUMENTS, filed May 1, 2018, ofU.S. Provisional Patent Application Ser. No. 62/665,129, entitledSURGICAL SUTURING SYSTEMS, filed May 1, 2018, of U.S. Provisional PatentApplication Ser. No. 62/665,134, entitled SURGICAL CLIP APPLIER, filedMay 1, 2018, of U.S. Provisional Patent Application Ser. No. 62/665,139,entitled SURGICAL INSTRUMENTS COMPRISING CONTROL SYSTEMS, filed May 1,2018, of U.S. Provisional Patent Application Ser. No. 62/665,177,entitled SURGICAL INSTRUMENTS COMPRISING HANDLE ARRANGEMENTS, filed May1, 2018, and of U.S. Provisional Patent Application Ser. No. 62/665,192,entitled SURGICAL DISSECTORS, filed May 1, 2018, the disclosures ofwhich are incorporated by reference herein in their entireties. Thisapplication claims the benefit of U.S. Provisional Patent ApplicationSer. No. 62/649,291, entitled USE OF LASER LIGHT AND RED-GREEN-BLUECOLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT, filed Mar.28, 2018, of U.S. Provisional Patent Application Ser. No. 62/649,294,entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATEANONYMIZED RECORD, filed Mar. 28, 2018, of U.S. Provisional PatentApplication Ser. No. 62/649,296, entitled ADAPTIVE CONTROL PROGRAMUPDATES FOR SURGICAL DEVICES, filed Mar. 28, 2018, of U.S. ProvisionalPatent Application Ser. No. 62/649,300, entitled SURGICAL HUBSITUATIONAL AWARENESS, filed Mar. 28, 2018, of U.S. Provisional PatentApplication Ser. No. 62/649,302, entitled INTERACTIVE SURGICAL SYSTEMSWITH ENCRYPTED COMMUNICATION CAPABILITIES, filed Mar. 28, 2018, of U.S.Provisional Patent Application Ser. No. 62/649,307, entitled AUTOMATICTOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS, filed Mar. 28,2018, of U.S. Provisional Patent Application Ser. No. 62/649,309,entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES INOPERATING THEATER, filed Mar. 28, 2018, of U.S. Provisional PatentApplication Ser. No. 62/649,310, entitled COMPUTER IMPLEMENTEDINTERACTIVE SURGICAL SYSTEMS, filed Mar. 28, 2018, of U.S. ProvisionalPatent Application Ser. No. 62/649,313, entitled CLOUD INTERFACE FORCOUPLED SURGICAL DEVICES, filed Mar. 28, 2018, of U.S. ProvisionalPatent Application Ser. No. 62/649,315, entitled DATA HANDLING ANDPRIORITIZATION IN A CLOUD ANALYTICS NETWORK, filed Mar. 28, 2018, ofU.S. Provisional Patent Application Ser. No. 62/649,320, entitled DRIVEARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS, filed Mar. 28, 2018,of U.S. Provisional Patent Application Ser. No. 62/649,323, entitledSENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS, filed Mar.28, 2018, of U.S. Provisional Patent Application Ser. No. 62/649,327,entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATIONTRENDS AND REACTIVE MEASURES, filed Mar. 28, 2018, and of U.S.Provisional Patent Application Ser. No. 62/649,333, entitled CLOUD-BASEDMEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER, filedMar. 28, 2018, the disclosures of which are incorporated by referenceherein in their entireties. This application claims the benefit of U.S.Provisional Patent Application Ser. No. 62/611,339, entitled ROBOTASSISTED SURGICAL PLATFORM, filed Dec. 28, 2017, of U.S. ProvisionalPatent Application Ser. No. 62/611,340, entitled CLOUD-BASED MEDICALANALYTICS, filed Dec. 28, 2017, and of U.S. Provisional PatentApplication Ser. No. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM,filed Dec. 28, 2017, the disclosures of which are incorporated byreference herein in their entireties. This application claims thebenefit of U.S. Provisional Patent Application Ser. No. 62/578,793,entitled SURGICAL INSTRUMENT WITH REMOTE RELEASE, filed Oct. 30, 2017,of U.S. Provisional Patent Application Ser. No. 62/578,804, entitledSURGICAL INSTRUMENT HAVING DUAL ROTATABLE MEMBERS TO EFFECT DIFFERENTTYPES OF END EFFECTOR MOVEMENT, filed Oct. 30, 2017, of U.S. ProvisionalPatent Application Ser. No. 62/578,817, entitled SURGICAL INSTRUMENTWITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END EFFECTOR FUNCTIONS,filed Oct. 30, 2017, of U.S. Provisional Patent Application Ser. No.62/578,835, entitled SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELYACTUATING MULTIPLE END EFFECTOR FUNCTIONS, filed Oct. 30, 2017, of U.S.Provisional Patent Application Ser. No. 62/578,844, entitled SURGICALINSTRUMENT WITH MODULAR POWER SOURCES, filed Oct. 30, 2017, and of U.S.Provisional Patent Application Ser. No. 62/578,855, entitled SURGICALINSTRUMENT WITH SENSOR AND/OR CONTROL SYSTEMS, filed Oct. 30, 2017, thedisclosures of which are incorporated by reference herein in theirentireties.

BACKGROUND

A variety of fasteners can be utilized to treat, clamp, fasten, secure,and/or hold tissue. Clips can be positioned relative to tissue locatedwithin a surgical site in a patient and then deformed to apply aclamping force, for example, to the tissue.

BRIEF DESCRIPTION OF THE DRAWINGS

The features and advantages of this invention, and the manner ofattaining them, will become more apparent and the invention itself willbe better understood by reference to the following description ofexemplary embodiments of the invention taken in conjunction with theaccompanying drawings, wherein:

FIG. 1 is a partial perspective view of a clip applier;

FIG. 2 is a cross-sectional view of an end effector of the clip applierof FIG. 1 comprising a removable clip cartridge, a reciprocating firingdrive for sequentially advancing the clips, a receiver for receiving theclips, and a crimping drive for deforming the clips;

FIG. 3 is a partial cross-sectional view of the clip applier of FIG. 1in an open configuration;

FIG. 4 is a partial cross-sectional view of the clip applier of FIG. 1in a closed configuration;

FIG. 5 is a cross-sectional view of the end effector of FIG. 2 in anunfired condition;

FIG. 6 is a cross-sectional view of the end effector of FIG. 2illustrating the firing drive in a partially fired condition in which afiring member of the firing drive has advanced a clip into the receiver;

FIG. 7 is a cross-sectional view of the end effector of FIG. 2illustrating the firing drive coming into engagement with the crimpingdrive;

FIG. 8 is a cross-sectional view of the end effector of FIG. 2illustrating the crimping drive in an at least partially firedcondition;

FIG. 9 is a cross-sectional view of the end effector of FIG. 2illustrating the firing drive becoming disengaged from the firingmember;

FIG. 10 is a cross-sectional view of the end effector of FIG. 2illustrating the crimping drive in its fully fired condition;

FIG. 11 is a cross-sectional view of the firing drive of the endeffector of FIG. 2 in a partially retracted position in which the firingdrive is being re-engaged with the firing member;

FIG. 12 is a cross-sectional view of the firing drive of the endeffector of FIG. 2 being disengaged from the crimping drive;

FIG. 13 is a perspective view of a clip illustrated in FIGS. 2-12;

FIG. 14 is a front view of a cartridge illustrated in FIGS. 1-12comprising a plurality of clips with portions of the cartridge removedto illustrate the clips stored in the cartridge;

FIG. 15 is a side view of the cartridge of FIG. 14 illustrated withportions removed to illustrate the clips stored in the cartridge;

FIG. 16 is a cross-sectional plan view of the cartridge of FIG. 14 takenalong line 16-16 in FIG. 15;

FIG. 17 is a side view of an alternative cartridge usable in connectionwith the clip applier of FIGS. 1-12 or any other suitable clip applier,wherein the cartridge is illustrated with portions removed to illustratea biasing member and a pusher plate positioned intermediate the biasingmember and the clips contained therein;

FIG. 18 is a side view of a cartridge in accordance with at least onealternative embodiment illustrated with portions removed to illustrate abiasing member and a lockout plate positioned intermediate the biasingmember and the clips contained therein;

FIG. 19 is a cross-sectional plan view of the cartridge of FIG. 18 takenalong line 19-19 in FIG. 18;

FIG. 20 is a side view of a further alternative cartridge usable inconnection with the clip applier of FIGS. 1-12 or any other suitableclip applier, wherein the cartridge can comprise a housing illustratedwith portions removed to illustrate a lockout plate comprising guideswhich are configured to co-operate with guides defined in the cartridgehousing;

FIG. 21 is a cross-sectional plan view of the cartridge of FIG. 20 takenalong line 21-21 in FIG. 20;

FIG. 22 is an elevational view of a firing drive comprising a rotaryinput, a rotary output, a firing nut engaged with the rotary output, anda transmission in a firing configuration in accordance with at least oneembodiment;

FIG. 23 is a perspective view of the firing drive of FIG. 22illustrating the firing nut in an unfired position;

FIG. 24 is a perspective view of the firing drive of FIG. 22illustrating the firing nut advanced along the rotary output and a camextending from the firing nut;

FIG. 25 is a perspective view of the firing drive of FIG. 22illustrating the cam of the firing nut engaged with the transmission ofthe firing drive and the transmission in a reverse configuration;

FIG. 26 is a perspective view of the firing drive of FIG. 22illustrating firing nut in a retracted position and a second camextending from the firing nut engaged with the transmission to shift thetransmission from its reverse configuration to its firing configuration;

FIG. 27 is a perspective view of a robotic surgical instrument systemoperably supporting a plurality of surgical tools usable with the clipapplier of FIGS. 2-12 or any other suitable clip applier;

FIG. 28 is a perspective view of a surgical tool including an actuatormodule, a shaft extending from the actuator module, and a replaceableend effector;

FIG. 29 is a perspective view of a handle actuator usable with the clipapplier of FIGS. 2-12 or any other suitable clip applier;

FIG. 30 is a cross-sectional view of the articulation joint illustratedin FIG. 2;

FIG. 31 is a rear perspective view of an alternative actuator modulethat may be used in place of the actuator module of FIG. 28 with atleast a portion of its housing removed;

FIG. 32 is an exploded view of a portion of the actuator module of FIG.31;

FIG. 33 is a partial sectional view of the actuator module of FIG. 31;

FIG. 34 is a cross-sectional view of an articulation actuator of theactuator module of FIG. 31;

FIG. 35A is a partial cross-sectional view of an end effector of a clipapplier in a closed configuration;

FIG. 35B is a partial cross-sectional view of the end effector of FIG.35A in an open configuration;

FIG. 35C is a cross-sectional view of the end effector of FIG. 35A in anopen configuration;

FIG. 36 is a partial cross-sectional view of the end effector of FIG.35A illustrating the position of a stored clip when a crimping drive ofthe end effector is in a fully fired position;

FIG. 37 is a partial cross-sectional view of the end effector of FIG.35A illustrating the position of the stored clip when the crimping driveis in a home position;

FIG. 38 is a partial cross-sectional view of the end effector of FIG.35A illustrating the position of the stored clip when the crimping driveis in a fully retracted position;

FIG. 39 is a partial cross-sectional view of a clip applier comprising aclip cartridge containing clips having a first size;

FIG. 40 is a partial cross-sectional view of the clip applier of FIG. 39comprising a different clip cartridge containing clips having a secondsize;

FIG. 41 is a partial cross-sectional view of a multi-level clip stackarrangement;

FIG. 42A is a perspective view of a clip applier comprising anattachment mechanism;

FIG. 42B is a cross-sectional view of the clip applier of FIG. 42A;

FIG. 43A is a perspective view of a clip applier comprising a clipmagazine;

FIG. 43B is a perspective view of clips for use with the clip applier ofFIG. 43A;

FIG. 44 is a perspective view of a clip reloader for use with a clipapplier comprising a clip magazine;

FIG. 45 is a perspective view of a clip reloader;

FIG. 46 is a cross-sectional view of the clip reloader of FIG. 45;

FIG. 47 is a cross-sectional view of the clip reloader of FIG. 45 and anend effector of a clip applier;

FIG. 48 is a partial cross-sectional plan view of a clip applier;

FIG. 49 is a partial cross-sectional side view of the clip applier ofFIG. 48;

FIG. 50 is a perspective view of the clip applier of FIG. 48;

FIG. 51A is a perspective view of a clip including a flexible base;

FIG. 51B is a side view of the clip of FIG. 51A in variousconfigurations;

FIG. 51C is a perspective view of a clip for use with a clip applier;

FIG. 51D is a side view of the clip of FIG. 51C in a storageconfiguration;

FIG. 51E is a side view of the clip of FIG. 51C in a pre-firingconfiguration;

FIG. 51F is a side view of the clip of FIG. 51C in a post-firingconfiguration;

FIG. 52 is a perspective view of a clip applier including a rotatableclip magazine;

FIG. 53 is a partial cross-sectional view of the clip applier of FIG. 52illustrating a closure tube of the clip applier in a fully retractedposition;

FIG. 54A is a partial cross-sectional view of the clip applier of FIG.52 illustrating the closure tube in a home position;

FIG. 54B is a perspective view of a ground portion including a clockingportion of the clip applier of FIG. 52;

FIG. 55 is a partial cross-sectional view of the clip applier of FIG. 52illustrating clips stored in the rotatable clip magazine prior to beingadvanced, illustrated with some components removed;

FIG. 56 is a partial cross-sectional view of the clip applier of FIG. 52illustrating a clip being advanced from the rotatable clip magazine by afeeder member of the clip applier;

FIG. 57 is a partial cross-sectional view of the clip applier of FIG. 52illustrating the feeder member retracted;

FIG. 58 is a partial cross-sectional view of the clip applier for FIG.52 illustrating a closure tube of the clip applier in a fully retractedposition;

FIG. 59 is a partial cross-sectional view of the clip applier of FIG. 52illustrating the closure tube in a home position and a firing memberadvancing a clip, illustrated with some components removed;

FIG. 60 is a partial cross-sectional view of the clip applier of FIG. 53illustrating the firing member retracted and the closure tube in a fullyadvanced position, illustrated with some components removed;

FIG. 61 is a partial cross-sectional view of a clip applier comprising areplaceable cartridge;

FIG. 62A is a cross-sectional end view of a rotatable clip magazine;

FIG. 62B is a plan view of a clip for use with the rotatable clipmagazine of FIG. 62A;

FIG. 63A is a perspective view of a releasable clip cartridge includingan articulation joint;

FIG. 63B is a partial cross-sectional view of the releasable clipcartridge and articulation joint of FIG. 63A;

FIG. 64 is a perspective view of a clip applier including anarticulation joint;

FIG. 65 is a partial cross-sectional view of a clip applier jawassembly;

FIG. 66A is a partial cross-sectional view of clip applier jaw assemblyincluding offset support legs;

FIG. 66B is a partial cross-sectional view of the clip applier jawassembly of FIG. 66A;

FIG. 67 is a partial cross sectional plan view of the clip applier jawassembly of FIG. 65;

FIG. 68 is a partial cross sectional plan view of the clip applier jawassembly of FIG. 66A;

FIG. 69 is a graphical depiction of the movements of a cam member and afeeder shoe of a clip applier throughout the operation of the clipapplier;

FIG. 70 is a graph depicting the displacement of a cam member and feedershoe of the clip applier of FIG. 52 as a function of time;

FIG. 71 depicts a first graph illustrating the force to advance a clipof a clip applier as a function of displacement and a second graphillustrating the voltage of a motor of the clip applier as a function oftime;

FIG. 72 depicts a graph of the force applied to a pair of jaws of a clipapplier versus time;

FIG. 73 is directed to an alternative embodiment;

FIG. 74 is directed to an alternative embodiment;

FIG. 75 is a perspective view of a clip applier including a rotatingclip magazine, a magnet, and a Hall Effect sensor;

FIG. 76 is a graphical depiction of the clip applier of FIG. 75illustrating the voltage of the Hall Effect sensor as a function of theposition of the magnet over time;

FIG. 77 is a partial cross-sectional view of a clip applier includingresistive sensing circuits;

FIG. 78A is a partial cross-sectional view of a clip applier including avariable resistance meter;

FIG. 78B is a partial cross-sectional view of the clip applier of FIG.78A in a partially crimped configuration;

FIG. 79 is a perspective view of a clip applier jaw including straingauges;

FIG. 80 is a graphical depiction of the clip applier jaw of FIG. 79illustrating the voltage of the strain gauges as a function of time;

FIG. 81A is a partial cross-sectional view of a clip applier including asensor array and a magnet;

FIG. 81B is a partial cross-sectional view of the clip applier of FIG.81A;

FIG. 82 is a perspective view of a clip applier system utilizing atrocar;

FIG. 83 is a perspective view of the clip applier system of FIG. 82;

FIG. 84A is a partial side elevational view of the clip applier systemof FIG. 82 depicting a jaw wing of a clip applier of the clip appliersystem positioned distal to a loading arm of a clip magazine of the clipapplier system;

FIG. 84B is a partial side elevational view of the clip applier systemof FIG. 82 depicting the jaw wing of the clip applier positionedproximal to the loading arm of the clip magazine;

FIG. 84C is a partial side elevational view of the clip applier systemof FIG. 82 depicting the jaw wing of the clip applier positionedproximal to the loading arm of the clip magazine;

FIG. 85A is a partial perspective view of the clip applier system ofFIG. 82;

FIG. 85B is a cross-sectional perspective view of the clip appliersystem of FIG. 82;

FIG. 86A is a plan view of the clip applier system of FIG. 82 depictinga jaw wing of the clip applier in an expanded configuration;

FIG. 86B is a plan view of the clip applier system of FIG. 82 depictingthe jaw wing of the clip applier in a retracted configuration;

FIG. 87A is a perspective view of a clip applier and a clip magazine foruse with the clip applier;

FIG. 87B is a perspective view of the clip magazine seated into the clipapplier of FIG. 87A;

FIG. 87C is a perspective view of the clip applier and the clip magazineof FIG. 87A in a loaded configuration;

FIG. 87D is a cross-sectional view of the clip applier and the clipmagazine of FIG. 87A in the loaded configuration of FIG. 87C;

FIG. 88A is a perspective view the spent clip magazine removed from theclip applier of FIG. 87A;

FIG. 88B is a plan view of the spent clip magazine seated into the clipapplier of FIG. 87A;

FIG. 88C is a cross-sectional plan view of the clip applier and the clipmagazine of FIG. 87A;

FIG. 88D is a cross-sectional plan view of the clip applier and the clipmagazine of FIG. 87A in a nearly spent configuration; and

FIG. 89 is a side elevational view of a clip applier utilizing aninterchangeable clip magazine;

FIG. 90A is a side elevational view of a distal head releasably attachedto a shaft of a clip applier;

FIG. 90B is a front elevational view of the distal head and shaft ofFIG. 90A;

FIG. 91A is a side elevational view of a distal head releasably attachedto a shaft of a clip applier;

FIG. 91B is a front elevational view of the distal head and shaft ofFIG. 91A

FIG. 92A is a side elevational view of a distal head releasably attachedto a shaft of a clip applier;

FIG. 92B is a front elevational view of the distal head and shaft ofFIG. 92A;

FIG. 93A is an exploded perspective view of a clip applier systemcomprising interchangeable distal heads that are releasably attachableto a clip applier;

FIG. 93B is a cross-sectional view of a quick disconnect configured foruse between a shaft and a distal head of a clip applier;

FIG. 93C is a cross-sectional view of the quick disconnect of FIG. 93B;

FIG. 93D is a cross-sectional front view of the quick disconnect of FIG.93B;

FIG. 94 is a cross-sectional view of a clip magazine including clipsthat are stacked in an offset manner;

FIG. 95A is a cross-sectional view of a clip magazine including anopening for an internal drive of a clip applier;

FIG. 95B is a cross-sectional view of a clip magazine comprising slantedclip channels and an opening for an internal drive of a clip applier;

FIG. 95C is a cross-sectional view of a clip magazine for use with aclip applier;

FIG. 95D is a cross-sectional view of a clip magazine for use with aclip applier;

FIG. 95E is a cross-sectional view of a clip magazine comprising clipsstacked in a non-concentric radial array;

FIG. 96 is a perspective view of a clip magazine comprising an angledclip storage channel;

FIG. 97A is a cross-sectional view of a clip magazine including aplurality of clips and a lockout, illustrated with the clip magazine ina firing position;

FIG. 97B is a cross-sectional side elevation view of the clip magazineof FIG. 97A;

FIG. 98 is a cross-sectional view of the clip magazine of FIG. 97A whichhas been rotated counter clock-wise approximately 30 degrees from thefiring position of FIG. 97A toward a clip loading position;

FIG. 99 is a cross-sectional view of the clip magazine of FIG. 97A whichhas been rotated counter clock-wise approximately 60 degrees from thefiring position of FIG. 97A toward the clip loading position;

FIG. 100 is a cross-sectional view of the clip magazine of FIG. 97A inthe clip loading position, wherein a clip is positioned in a loadingslot;

FIG. 101 is a cross-section view of the clip magazine of FIG. 97A in theclip loading position, wherein a lockout clip is positioned in theloading slot;

FIG. 102 is a perspective view of a clip applier comprising a clipmagazine and a rotary input, illustrated with the clip magazine is in aproximal position;

FIG. 103 is a perspective view of the clip applier of FIG. 102,illustrated with the clip magazine is in a distal position;

FIG. 104 is a perspective view of the clip applier of FIG. 102,illustrated with the clip magazine is in the distal position and hasrotated approximately 120 degrees;

FIG. 105 is a perspective view of the clip applier of FIG. 102 includinga feeder shoe, a crimping drive, and a shaft comprising a loading slot,wherein the loading slot has a clip from the clip magazine storedtherein;

FIG. 106 is a perspective exploded view of the clip applier of FIG. 105;

FIG. 107 is a cross-sectional view of a rotary input and a clip magazinefor use with a clip applier, wherein the rotary input is amulti-directional rotary input;

FIG. 108 is a cross-sectional side view of a rotary input and a clipmagazine for use with a clip applier, wherein the rotary input is amulti-directional rotary input;

FIG. 109 is a cross-sectional front view of the rotary input and clipmagazine of FIG. 108;

FIG. 110 is a cross-sectional view of a rotary input and a clip magazinefor use with a clip applier, wherein the rotary input is asingle-direction rotary input;

FIG. 111 is a cross-sectional view of a rotary input, a clip magazine,and a loading slot for use with a clip applier, wherein the rotary inputis a single-direction rotary input;

FIG. 112 is a perspective view of a rotary input and a clip magazine foruse with a clip applier, wherein the clip magazine includes a clam-shellconstruction;

FIG. 113 is a cross-sectional front view of the clip magazine of FIG.112;

FIG. 114 is an exploded perspective view of a clip applier comprising aclip magazine and a magazine driver, wherein the clip magazine andmagazine driver comprise camming surfaces;

FIG. 115A is a side elevational view of the clip applier of FIG. 114,illustrated with the clip magazine in a proximal position;

FIG. 115B is a side elevational view of the rotatable clip magazine ofFIG. 114 wherein the cam advancer has advanced the rotatable clipmagazine from the proximal position to a distal position;

FIG. 115C is a side elevational view of the rotatable clip magazine ofFIG. 114 in a ready to clock position relative to the cam advancer ofFIG. 114;

FIG. 116 is a graphical depiction of the absolute rotary position of themagazine driver of the clip applier of FIG. 114 during an operationsequence;

FIG. 117 is a cross-sectional view of a clip applier comprising an endeffector, a clip magazine, a clip carriage, and a clip former configuredto form a clip from the clip magazine;

FIG. 118A is a cross-sectional view of the clip applier of FIG. 117depicting the clip carriage holding a clip with portions of the clipapplier removed for the purpose of illustration;

FIG. 118B is a cross-sectional view of the clip applier of FIG. 117depicting the clip carriage advancing a clip into a staging positionwith portions of the clip applier removed for the purpose ofillustration;

FIG. 118C is a cross-sectional view of the clip applier of FIG. 117depicting the clip carriage retracted and a clip in the staging positionwith portions of the clip applier removed for the purpose ofillustration;

FIG. 118D is a cross-sectional view of the clip applier of FIG. 117depicting the clip carriage advancing a clip in the staging positioninto the end effector with portions of the clip applier removed for thepurpose of illustration;

FIG. 119A is a cross-sectional view of the clip applier of FIG. 117depicting the clip carriage retracted a clip to a forming position,wherein the an anvil is positioned above the clip;

FIG. 119B is a cross-sectional view of the clip applier of FIG. 117depicting the clip carriage retracted a clip to the forming position,wherein the an anvil is positioned in between a first leg and a secondleg of the clip;

FIG. 120A is a plan view of the clip carriage and anvil of the clipapplier of FIG. 117, wherein a clip has been positioned around theanvil, and wherein the clip is in an unformed state;

FIG. 120B is a plan view of the clip carriage and anvil of the clipapplier of FIG. 117, wherein a clip has been positioned around theanvil, and wherein the clip is in a formed state;

FIG. 121 is a cross-sectional view of the clip applier of FIG. 117;

FIG. 122 is a perspective view of a clip applier comprising an endeffector, a clip magazine, and co-axial rotary inputs comprised ofdual-woven cables;

FIG. 123 is a perspective view of a clip applier comprising an endeffector, a clip magazine, and co-axial rotary inputs comprises of wiretubing;

FIG. 124 is a perspective view of rotary input for use with a clipapplier, wherein the rotary input comprises layers of coiled springswound in opposite directions;

FIG. 125 is a perspective view of a clip applier comprising a shaft, aclip magazine, and a clip advancer configured to advance clips from theclip magazine into a loading slot, then into a staging position, andthen into a clip track of the clip applier, wherein a first clip isshown in the clip magazine;

FIG. 126 is a perspective view of the clip applier of FIG. 125 depictingthe first clip being advanced into the loading slot of the clip applieras the clip magazine moves distally;

FIG. 127 is a perspective view of the clip applier of FIG. 125 depictingthe first clip being stripped from the clip magazine by the loading slotof the clip applier as the clip magazine is rotated and retracted;

FIG. 128 is a perspective view of the clip applier of FIG. 125 depictingthe first clip in the loading slot as the clip magazine is furtherrotated and retracted;

FIG. 129 is a perspective view of the clip applier of FIG. 125 depictingthe first clip in the loading slot as the clip magazine is fullyretracted placing the first clip in a position to be advanced throughthe loading slot;

FIG. 130 is a perspective view of the clip applier of FIG. 125 depictingthe first clip in the loading slot as the clip magazine is advanced toengage the clip advancer with the backside of the first clip;

FIG. 131 is a perspective view of the clip applier of FIG. 125 depictingthe first clip after it has been advanced through the loading slot bythe clip advancer;

FIG. 132 is a perspective view of the clip applier of FIG. 125 depictingthe first clip after it has been advanced out of the loading slot intothe staging position by the clip advancer;

FIG. 133 is a perspective view of the clip applier of FIG. 125 depictingthe first clip positioned in the staging position and the clip advancerand clip magazine retracted;

FIG. 134 is a perspective view of the clip applier of FIG. 125 depictingthe clip magazine and the clip advancer advanced and abutted against thefirst clip in the staging position;

FIG. 135 is a perspective view of the clip applier of FIG. 125 depictingthe first clip after it has been advanced from the staging position intothe clip track by the clip advancer;

FIG. 136 is a perspective view of the clip applier of FIG. 125 depictingthe first clip after it has been completely advanced into the clip trackby the clip advancer;

FIG. 137 is a perspective view of the clip applier of FIG. 125 depictingthe first clip after it has been advanced through the loading slot, witha second clip positioned in the loading slot and a third clip positionedin the clip magazine;

FIG. 138 is a perspective view of the clip applier of FIG. 125 depictingthe first clip in the clip track, the second clip in the stagingposition, and the third clip in the loading slot;

FIG. 139 is a perspective view of the clip applier of FIG. 125 depictingthe first clip in the clip track, the second clip in the stagingposition, the third clip in the loading slot, and a fourth clip in theclip magazine;

FIG. 140 is a perspective view of the clip applier of FIG. 125 depictingthe first clip in the clip track, the second clip in the clip track, thethird clip in the staging position, and a fourth clip in the loadingslot;

FIG. 141A is a perspective view of the clip applier of FIG. 125depicting an end effector extending from the shaft of the clip applier,wherein the first clip is in the clip track, the second clip is in theclip track, the third clip is in the staging position, a fourth clip isin the loading slot, and a fifth clip is in the clip magazine.

FIG. 141B is a perspective view of the clip applier of FIG. 125, whereinthe first, second, third, fourth, and fifth clips have been advancedtoward the end effector.

FIG. 141C is a perspective view of the clip applier of FIG. 125, whereinthe first clip has been advanced into the end effector.

FIG. 142 is a perspective view of the clip applier of FIG. 125 depictinga jaw cam and feeder shoe mounted to the end effector.

FIG. 143 is a perspective view of the clip applier of FIG. 125 depictingthe feeder shoe engaged with the backside of the first clip and the jawcam in a proximal position.

FIG. 144A is a perspective view of an alternative embodiment of a jawcam for use with the end effector of the clip applier of FIG. 125,illustrated with the jaw cam in a proximal position;

FIG. 144B is a perspective view of the alternative embodiment of FIG.144A, illustrated with the jaw cam in a distal position.

FIG. 144C is a perspective view of the alternative embodiment of FIG.144B, illustrated with the jaw cam in a closing position;

FIG. 145 is a perspective view of a clip applier comprising atranslatable clip magazine and a translatable and rotatable clipadvancer configured to advance a clip;

FIG. 146 is a plan view of the clip applier of FIG. 145, illustratingthe clip magazine and clip advancer in proximal positions;

FIG. 147 is a plan view of the clip applier of FIG. 145, illustratingthe clip magazine and clip advancer moved distally from their proximalpositions to advance the clip;

FIG. 148 is a plan view of the clip applier of FIG. 145, illustratingthe clip magazine and clip advancer moved to their distal-most positionsto completely advance the clip;

FIG. 149 is a plan view of the clip applier of FIG. 145, illustratingthe clip magazine and clip advancer partially retracted from theirdistal-most positions toward their proximal position;

FIG. 150 is a plan view of the clip applier of FIG. 145, illustratingthe clip magazine and clip advancer in their proximal positions;

FIG. 151A is a side view of the clip applier of FIG. 145, illustratingthe clip magazine and clip advancer in their proximal positions with theclip ready to be advanced;

FIG. 151B is a side view of the clip applier of FIG. 145, illustratingthe clip magazine and clip advancer in their distal-most positions afteradvancing the clip;

FIG. 152 is a perspective view of a clip applier comprising an endeffector spanning two different planes, a clip magazine, and a rotaryinput extending through the clip magazine;

FIG. 153 is a cross-sectional view of the clip applier of FIG. 152depicting a portion of the end effector and the rotary input extendingthrough the clip magazine;

FIG. 154 is a cross-sectional view of the clip applier of FIG. 152depicting an anchor portion of the end effector extending through theclip magazine;

FIG. 155 is a cross-sectional view of the clip applier of FIG. 152depicting a portion of the end effector and the rotary input extendingthrough the clip magazine including clip holders;

FIG. 156 is a perspective view of a clip applier comprising an endeffector extending from a shaft, and a clip magazine, wherein the endeffector spans two different planes;

FIG. 157 is a side view of the clip applier of FIG. 156;

FIG. 158 is a perspective view of the clip applier of FIG. 156 depictinga collar of the clip applier being installed onto the end effector;

FIG. 159 is a perspective view of the clip applier of FIG. 156 depictingthe collar of the clip applier installed onto the end effector;

FIG. 160 is a perspective view of an end effector of an alternativeembodiment.

FIG. 161 is a side view of a clip applier comprising a drive screw withtwo different thread pitches configured to move a camming member and afeeder shoe in opposite directions to advance and crimp a clip,illustrating the camming member in a proximal position and the feedershoe in a distal position;

FIG. 162 is a side view of the clip applier of FIG. 161, illustratingthe camming member in a distal position and the feeder shoe in aproximal position;

FIG. 163 is a plan view of a clip applier comprising an end effectorincluding jaws configured to close parallel to one another in responseto a rotation of a drive screw, illustrating the jaws in an openposition;

FIG. 164 is a plan view of the clip applier of FIG. 163, illustratingthe jaws in a closed position;

FIG. 165 is a plan view of a clip applier comprising an end effectorincluding jaws configured to provide tip first closure in response to arotation of a drive screw, illustrating the jaws in an open position;

FIG. 166 is a plan view of the clip applier of FIG. 165, illustratingthe jaws in a closed position;

FIG. 167A is a side elevational view of a clip applier comprising a jawcam and a clip advancer, wherein the clip applier is configured toadvance a clip and approximate a pair of jaws in response to the samerotary input, illustrating the jaw cam in a distal position and the jawsin a closed configuration;

FIG. 167B is a side elevational view of the clip applier of FIG. 167A,illustrating the pair of jaws in an open configuration and the jaw camretracted to a proximal position;

FIG. 167C is a side elevational view of the clip applier of FIG. 167A,illustrating the pair of jaws in the open configuration and the jaw camretracted to a fully-retracted position to release the clip advancer andto advance a clip into the pair of jaws;

FIG. 167D is a side elevational view of the clip applier of FIG. 167A,wherein a shoe retrieval latch of the jaw cam is operably engaged withthe clip advancer when the jaw cam is advanced again to the distalposition;

FIG. 168 is a perspective view of the jaw cam and the shoe retrievallatch of the clip applier of FIG. 167A;

FIG. 169 is a perspective view of the jaw cam and the shoe retrievallatch of the clip applier of FIG. 167A engaging a feeder shoe of theclip advancer;

FIG. 170 is a perspective view of a clip applier comprising a cam memberand a clip advancer threadably engaged with a rotary input andconfigured to advance a clip and approximate a pair of opposing jaws,wherein the cam member and clip advancer are in a proximal position andthe pair of jaws are closed;

FIG. 171 is a perspective view of the clip applier of FIG. 170, whereinthe cam member and clip advancer are in an intermediate position and thepair of jaws are open;

FIG. 172 is a perspective view of the clip applier of FIG. 170, whereinthe cam member and clip advancer are in a distal position, the pair ofjaws are open, and a clip has been advanced into the pair of jaws;

FIG. 173 is a cross-sectional side view of the clip applier of FIG. 170,wherein the cam member and clip advancer are in the proximal positionand the pair of jaws are closed;

FIG. 174 is a cross-sectional side view of the clip applier of FIG. 170,wherein the cam member and clip advancer are in the intermediateposition and the pair of jaws are open;

FIG. 175 is a cross-sectional side view of the clip applier of FIG. 170,wherein the cam member and clip advancer are in the distal position, thepair of jaws are open, and the clip has been advanced into the pair ofjaws;

FIG. 176 is a graphical depiction of a clip applier illustratingposition of a crimping drive of the clip applier over time and includingset points indicative of clip formation; and

FIG. 177 is a schematic of a control system for use with any of thesurgical instruments disclosed herein.

Corresponding reference characters indicate corresponding partsthroughout the several views. The exemplifications set out hereinillustrate various embodiments of the invention, in one form, and suchexemplifications are not to be construed as limiting the scope of theinvention in any manner.

DETAILED DESCRIPTION

Applicant of the present application owns the following U.S. PatentApplications that were filed on Oct. 26, 2018 and which are each hereinincorporated by reference in their respective entireties:

-   -   U.S. Patent Application Ser. No. 16/172,130, entitled CLIP        APPLIER COMPRISING INTERCHANGEABLE CLIP RELOADS, now U.S. Patent        Application Publication No. 2019/0125358;    -   U.S. Patent Application Ser. No. 16/172,066, entitled CLIP        APPLIER COMPRISING A MOVABLE CLIP MAGAZINE, now U.S. Patent        Application Publication No. 2019/0125355;    -   U.S. Patent Application Ser. No. 16/172,078, entitled CLIP        APPLIER COMPRISING A ROTATABLE CLIP MAGAZINE, now U.S. Patent        Application Publication No. 2019/0125356;    -   U.S. Patent Application Ser. No. 16/172,087, entitled CLIP        APPLIER COMPRISING CLIP ADVANCING SYSTEMS, now U.S. Patent        Application Publication No. 2019/0125339;    -   U.S. Patent Application Ser. No. 16/172,094, entitled CLIP        APPLIER COMPRISING A CLIP CRIMPING SYSTEM, now U.S. Patent        Application Publication No. 2019/0125357;    -   U.S. Patent Application Ser. No. 16/172,128, entitled CLIP        APPLIER COMPRISING A RECIPROCATING CLIP ADVANCING MEMBER, now        U.S. Patent Application Publication No. 2019/0159778; and    -   U.S. Patent Application Ser. No. 16/172,168, entitled CLIP        APPLIER COMPRISING A MOTOR CONTROLLER, now U.S. Patent        Application Publication No. 2019/0125360.

Applicant of the present application owns the following U.S. patentapplications that were filed on Aug. 24, 2018, which are each hereinincorporated by reference in their respective entireties:

U.S. patent application Ser. No. 16/112,129, entitled SURGICAL SUTURINGINSTRUMENT CONFIGURED TO MANIPULATE TISSUE USING MECHANICAL ANDELECTRICAL POWER;

U.S. patent application Ser. No. 16/112,155, entitled SURGICAL SUTURINGINSTRUMENT COMPRISING A CAPTURE WIDTH WHICH IS LARGER THAN TROCARDIAMETER;

U.S. patent application Ser. No. 16/112,168, entitled SURGICAL SUTURINGINSTRUMENT COMPRISING A NON-CIRCULAR NEEDLE;

U.S. patent application Ser. No. 16/112,180, entitled ELECTRICAL POWEROUTPUT CONTROL BASED ON MECHANICAL FORCES;

U.S. patent application Ser. No. 16/112,193, entitled REACTIVE ALGORITHMFOR SURGICAL SYSTEM;

U.S. patent application Ser. No. 16/112,099, entitled SURGICALINSTRUMENT COMPRISING AN ADAPTIVE ELECTRICAL SYSTEM;

U.S. patent application Ser. No. 16/112,112, entitled CONTROL SYSTEMARRANGEMENTS FOR A MODULAR SURGICAL INSTRUMENT;

U.S. patent application Ser. No. 16/112,119, entitled ADAPTIVE CONTROLPROGRAMS FOR A SURGICAL SYSTEM COMPRISING MORE THAN ONE TYPE OFCARTRIDGE;

U.S. patent application Ser. No. 16/112,097, entitled SURGICALINSTRUMENT SYSTEMS COMPRISING BATTERY ARRANGEMENTS;

U.S. patent application Ser. No. 16/112,109, entitled SURGICALINSTRUMENT SYSTEMS COMPRISING HANDLE ARRANGEMENTS;

U.S. patent application Ser. No. 16/112,114, entitled SURGICALINSTRUMENT SYSTEMS COMPRISING FEEDBACK MECHANISMS;

U.S. patent application Ser. No. 16/112,117, entitled SURGICALINSTRUMENT SYSTEMS COMPRISING LOCKOUT MECHANISMS;

U.S. patent application Ser. No. 16/112,095, entitled SURGICALINSTRUMENTS COMPRISING A LOCKABLE END EFFECTOR SOCKET;

U.S. patent application Ser. No. 16/112,121, entitled SURGICALINSTRUMENTS COMPRISING A SHIFTING MECHANISM;

U.S. patent application Ser. No. 16/112,151, entitled SURGICALINSTRUMENTS COMPRISING A SYSTEM FOR ARTICULATION AND ROTATIONCOMPENSATION;

U.S. patent application Ser. No. 16/112,154, entitled SURGICALINSTRUMENTS COMPRISING A BIASED SHIFTING MECHANISM;

U.S. patent application Ser. No. 16/112,226, entitled SURGICALINSTRUMENTS COMPRISING AN ARTICULATION DRIVE THAT PROVIDES FOR HIGHARTICULATION ANGLES;

U.S. patent application Ser. No. 16/112,062, entitled SURGICALDISSECTORS AND MANUFACTURING TECHNIQUES;

U.S. patent application Ser. No. 16/112,098, entitled SURGICALDISSECTORS CONFIGURED TO APPLY MECHANICAL AND ELECTRICAL ENERGY;

U.S. patent application Ser. No. 16/112,237, entitled SURGICAL CLIPAPPLIER CONFIGURED TO STORE CLIPS IN A STORED STATE;

U.S. patent application Ser. No. 16/112,245, entitled SURGICAL CLIPAPPLIER COMPRISING AN EMPTY CLIP CARTRIDGE LOCKOUT;

U.S. patent application Ser. No. 16/112,249, entitled SURGICAL CLIPAPPLIER COMPRISING AN AUTOMATIC CLIP FEEDING SYSTEM;

U.S. patent application Ser. No. 16/112,253, entitled SURGICAL CLIPAPPLIER COMPRISING ADAPTIVE FIRING CONTROL; and

U.S. patent application Ser. No. 16/112,257, entitled SURGICAL CLIPAPPLIER COMPRISING ADAPTIVE CONTROL IN RESPONSE TO A STRAIN GAUGECIRCUIT.

Applicant of the present application owns the following U.S. Patentapplications that were filed on May 1, 2018 and which are each hereinincorporated by reference in their respective entireties:

U.S. Provisional Patent Application Ser. No. 62/665,129, entitledSURGICAL SUTURING SYSTEMS;

U.S. Provisional Patent Application Ser. No. 62/665,139, entitledSURGICAL INSTRUMENTS COMPRISING CONTROL SYSTEMS;

U.S. Provisional Patent Application Ser. No. 62/665,177, entitledSURGICAL INSTRUMENTS COMPRISING HANDLE ARRANGEMENTS;

U.S. Provisional Patent Application Ser. No. 62/665,128, entitledMODULAR SURGICAL INSTRUMENTS;

U.S. Provisional Patent Application Ser. No. 62/665,192, entitledSURGICAL DISSECTORS; and

U.S. Provisional Patent Application Ser. No. 62/665,134, entitledSURGICAL CLIP APPLIER.

Applicant of the present application owns the following U.S. Patentapplications that were filed on Feb. 28, 2018 and which are each hereinincorporated by reference in their respective entireties:

U.S. patent application Ser. No. 15/908,021, entitled SURGICALINSTRUMENT WITH REMOTE RELEASE;

U.S. patent application Ser. No. 15/908,012, entitled SURGICALINSTRUMENT HAVING DUAL ROTATABLE MEMBERS TO EFFECT DIFFERENT TYPES OFEND EFFECTOR MOVEMENT;

U.S. patent application Ser. No. 15/908,040, entitled SURGICALINSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END EFFECTORFUNCTIONS;

U.S. patent application Ser. No. 15/908,057, entitled SURGICALINSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END EFFECTORFUNCTIONS;

U.S. patent application Ser. No. 15/908,058, entitled SURGICALINSTRUMENT WITH MODULAR POWER SOURCES; and

U.S. patent application Ser. No. 15/908,143, entitled SURGICALINSTRUMENT WITH SENSOR AND/OR CONTROL SYSTEMS.

Applicant of the present application owns the following U.S. Patentapplications that were filed on Oct. 30, 2017 and which are each hereinincorporated by reference in their respective entireties:

U.S. Provisional Patent Application Ser. No. 62/578,793, entitledSURGICAL INSTRUMENT WITH REMOTE RELEASE;

U.S. Provisional Patent Application Ser. No. 62/578,804, entitledSURGICAL INSTRUMENT HAVING DUAL ROTATABLE MEMBERS TO EFFECT DIFFERENTTYPES OF END EFFECTOR MOVEMENT;

U.S. Provisional Patent Application Ser. No. 62/578,817, entitledSURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE ENDEFFECTOR FUNCTIONS;

U.S. Provisional Patent Application Ser. No. 62/578,835, entitledSURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE ENDEFFECTOR FUNCTIONS;

U.S. Provisional Patent Application Ser. No. 62/578,844, entitledSURGICAL INSTRUMENT WITH MODULAR POWER SOURCES; and

U.S. Provisional Patent Application Ser. No. 62/578,855, entitledSURGICAL INSTRUMENT WITH SENSOR AND/OR CONTROL SYSTEMS.

Applicant of the present application owns the following U.S. Provisionalpatent applications, filed on Dec. 28, 2017, the disclosure of each ofwhich is herein incorporated by reference in its entirety:

U.S. Provisional Patent Application Ser. No. 62/611,341, entitledINTERACTIVE SURGICAL PLATFORM;

U.S. Provisional Patent Application Ser. No. 62/611,340, entitledCLOUD-BASED MEDICAL ANALYTICS; and

U.S. Provisional Patent Application Ser. No. 62/611,339, entitled ROBOTASSISTED SURGICAL PLATFORM.

Applicant of the present application owns the following U.S. Provisionalpatent applications, filed on Mar. 28, 2018, each of which is hereinincorporated by reference in its entirety:

U.S. Provisional Patent Application Ser. No. 62/649,302, entitledINTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES;

U.S. Provisional Patent Application Ser. No. 62/649,294, entitled DATASTRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZEDRECORD;

U.S. Provisional Patent Application Ser. No. 62/649,300, entitledSURGICAL HUB SITUATIONAL AWARENESS;

U.S. Provisional Patent Application Ser. No. 62/649,309, entitledSURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATINGTHEATER;

U.S. Provisional Patent Application Ser. No. 62/649,310, entitledCOMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;

U.S. Provisional Patent Application Ser. No. 62/649,291, entitled USE OFLASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OFBACK SCATTERED LIGHT;

U.S. Provisional Patent Application Ser. No. 62/649,296, entitledADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES;

U.S. Provisional Patent Application Ser. No. 62/649,333, entitledCLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO AUSER;

U.S. Provisional Patent Application Ser. No. 62/649,327, entitledCLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS ANDREACTIVE MEASURES;

U.S. Provisional Patent Application Ser. No. 62/649,315, entitled DATAHANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK;

U.S. Provisional Patent Application Ser. No. 62/649,313, entitled CLOUDINTERFACE FOR COUPLED SURGICAL DEVICES;

U.S. Provisional Patent Application Ser. No. 62/649,320, entitled DRIVEARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

U.S. Provisional Patent Application Ser. No. 62/649,307, entitledAUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and

U.S. Provisional Patent Application Ser. No. 62/649,323, entitledSENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.

Applicant of the present application owns the following U.S. Patentapplications, filed on Mar. 29, 2018, each of which is hereinincorporated by reference in its entirety:

U.S. patent application Ser. No. 15/940,641, entitled INTERACTIVESURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES;

U.S. patent application Ser. No. 15/940,648, entitled INTERACTIVESURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICES AND DATACAPABILITIES;

U.S. patent application Ser. No. 15/940,656, entitled SURGICAL HUBCOORDINATION OF CONTROL AND COMMUNICATION OF OPERATING ROOM DEVICES;

U.S. patent application Ser. No. 15/940,666, entitled SPATIAL AWARENESSOF SURGICAL HUBS IN OPERATING ROOMS;

U.S. patent application Ser. No. 15/940,670, entitled COOPERATIVEUTILIZATION OF DATA DERIVED FROM SECONDARY SOURCES BY INTELLIGENTSURGICAL HUBS;

U.S. patent application Ser. No. 15/940,677, entitled SURGICAL HUBCONTROL ARRANGEMENTS;

U.S. patent application Ser. No. 15/940,632, entitled DATA STRIPPINGMETHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD;

U.S. patent application Ser. No. 15/940,640, entitled COMMUNICATION HUBAND STORAGE DEVICE FOR STORING PARAMETERS AND STATUS OF A SURGICALDEVICE TO BE SHARED WITH CLOUD BASED ANALYTICS SYSTEMS;

U.S. patent application Ser. No. 15/940,645, entitled SELF DESCRIBINGDATA PACKETS GENERATED AT AN ISSUING INSTRUMENT;

U.S. patent application Ser. No. 15/940,649, entitled DATA PAIRING TOINTERCONNECT A DEVICE MEASURED PARAMETER WITH AN OUTCOME;

U.S. patent application Ser. No. 15/940,654, entitled SURGICAL HUBSITUATIONAL AWARENESS;

U.S. patent application Ser. No. 15/940,663, entitled SURGICAL SYSTEMDISTRIBUTED PROCESSING;

U.S. patent application Ser. No. 15/940,668, entitled AGGREGATION ANDREPORTING OF SURGICAL HUB DATA;

U.S. patent application Ser. No. 15/940,671, entitled SURGICAL HUBSPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER;

U.S. patent application Ser. No. 15/940,686, entitled DISPLAY OFALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE;

U.S. patent application Ser. No. 15/940,700, entitled STERILE FIELDINTERACTIVE CONTROL DISPLAYS;

U.S. patent application Ser. No. 15/940,629, entitled COMPUTERIMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;

U.S. patent application Ser. No. 15/940,704, entitled USE OF LASER LIGHTAND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTEREDLIGHT;

U.S. patent application Ser. No. 15/940,722, entitled CHARACTERIZATIONOF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHTREFRACTIVITY; and

U.S. patent application Ser. No. 15/940,742, entitled DUAL CMOS ARRAYIMAGING.

Applicant of the present application owns the following U.S. Patentapplications, filed on Mar. 29, 2018, each of which is hereinincorporated by reference in its entirety:

U.S. patent application Ser. No. 15/940,636, entitled ADAPTIVE CONTROLPROGRAM UPDATES FOR SURGICAL DEVICES;

U.S. patent application Ser. No. 15/940,653, entitled ADAPTIVE CONTROLPROGRAM UPDATES FOR SURGICAL HUBS;

U.S. patent application Ser. No. 15/940,660, entitled CLOUD-BASEDMEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER;

U.S. patent application Ser. No. 15/940,679, entitled CLOUD-BASEDMEDICAL ANALYTICS FOR LINKING OF LOCAL USAGE TRENDS WITH THE RESOURCEACQUISITION BEHAVIORS OF LARGER DATA SET;

U.S. patent application Ser. No. 15/940,694, entitled CLOUD-BASEDMEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED INDIVIDUALIZATION OFINSTRUMENT FUNCTION;

U.S. patent application Ser. No. 15/940,634, entitled CLOUD-BASEDMEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVEMEASURES;

U.S. patent application Ser. No. 15/940,706, entitled DATA HANDLING ANDPRIORITIZATION IN A CLOUD ANALYTICS NETWORK; and

U.S. patent application Ser. No. 15/940,675, entitled CLOUD INTERFACEFOR COUPLED SURGICAL DEVICES.

Applicant of the present application owns the following U.S. Patentapplications, filed on Mar. 29, 2018, each of which is hereinincorporated by reference in its entirety:

U.S. patent application Ser. No. 15/940,627, entitled DRIVE ARRANGEMENTSFOR ROBOT-ASSISTED SURGICAL PLATFORMS;

U.S. patent application Ser. No. 15/940,637, entitled COMMUNICATIONARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

U.S. patent application Ser. No. 15/940,642, entitled CONTROLS FORROBOT-ASSISTED SURGICAL PLATFORMS;

U.S. patent application Ser. No. 15/940,676, entitled AUTOMATIC TOOLADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

U.S. patent application Ser. No. 15/940,680, entitled CONTROLLERS FORROBOT-ASSISTED SURGICAL PLATFORMS;

U.S. patent application Ser. No. 15/940,683, entitled COOPERATIVESURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

U.S. patent application Ser. No. 15/940,690, entitled DISPLAYARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and

U.S. patent application Ser. No. 15/940,711, entitled SENSINGARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.

Applicant of the present application owns the following U.S. ProvisionalPatent applications, filed on Mar. 30, 2018, each of which is hereinincorporated by reference in its entirety:

U.S. Provisional Patent Application Ser. No. 62/650,887, entitledSURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES;

U.S. Provisional Patent Application Ser. No. 62/650,877, entitledSURGICAL SMOKE EVACUATION SENSING AND CONTROLS;

U.S. Provisional Patent Application Ser. No. 62/650,882, entitled SMOKEEVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM; and

U.S. Provisional Patent Application Ser. No. 62/650,898, entitledCAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS.

Applicant of the present application owns the following U.S. ProvisionalPatent application, filed on Apr. 19, 2018, which is herein incorporatedby reference in its entirety:

U.S. Provisional Patent Application Ser. No. 62/659,900, entitled METHODOF HUB COMMUNICATION.

Numerous specific details are set forth to provide a thoroughunderstanding of the overall structure, function, manufacture, and useof the embodiments as described in the specification and illustrated inthe accompanying drawings. Well-known operations, components, andelements have not been described in detail so as not to obscure theembodiments described in the specification. The reader will understandthat the embodiments described and illustrated herein are non-limitingexamples, and thus it can be appreciated that the specific structuraland functional details disclosed herein may be representative andillustrative. Variations and changes thereto may be made withoutdeparting from the scope of the claims.

The terms “comprise” (and any form of comprise, such as “comprises” and“comprising”), “have” (and any form of have, such as “has” and“having”), “include” (and any form of include, such as “includes” and“including”), and “contain” (and any form of contain, such as “contains”and “containing”) are open-ended linking verbs. As a result, a surgicalsystem, device, or apparatus that “comprises,” “has,” “includes”, or“contains” one or more elements possesses those one or more elements,but is not limited to possessing only those one or more elements.Likewise, an element of a system, device, or apparatus that “comprises,”“has,” “includes”, or “contains” one or more features possesses thoseone or more features, but is not limited to possessing only those one ormore features.

The terms “proximal” and “distal” are used herein with reference to aclinician manipulating the handle portion of the surgical instrument.The term “proximal” refers to the portion closest to the clinician andthe term “distal” refers to the portion located away from the clinician.It will be further appreciated that, for convenience and clarity,spatial terms such as “vertical”, “horizontal”, “up”, and “down” may beused herein with respect to the drawings. However, surgical instrumentsare used in many orientations and positions, and these terms are notintended to be limiting and/or absolute.

Various exemplary devices and methods are provided for performinglaparoscopic and minimally invasive surgical procedures. However, thereader will readily appreciate that the various methods and devicesdisclosed herein can be used in numerous surgical procedures andapplications including, for example, in connection with open surgicalprocedures. As the present Detailed Description proceeds, the readerwill further appreciate that the various instruments disclosed hereincan be inserted into a body in any way, such as through a naturalorifice, through an incision or puncture hole formed in tissue, etc. Theworking portions or end effector portions of the instruments can beinserted directly into a patient's body or can be inserted through anaccess device that has a working channel through which the end effectorand elongate shaft of a surgical instrument can be advanced.

During various surgical procedures, a surgeon, or other clinician, mayapply a clip to a patient's tissue in order to achieve various effectsand/or therapeutic results. Referring to FIG. 1, a surgical instrument,such as a clip applier 100, for example, can be configured to apply oneor more clips to tissue located within a surgical site in the patient.Generally, referring now to FIG. 13, the clip applier 100 can bestructured and arranged to position a clip 140 relative to the tissue inorder to compress the tissue within the clip 140. The clip applier 100can be configured to deform the clip 140 as illustrated in FIGS. 3 and4, for example, and as described in greater detail further below. Eachclip 140 can comprise a base 142 and opposing legs 144 extending fromthe base 142. The base 142 and the legs 144 can comprise any suitableshape and can define a substantially U-shaped configuration and/or asubstantially V-shaped configuration, for example. The base 142 cancomprise angled portions 141 which are connected together by a joint143. In use, the legs 144 of the clip 140 can be positioned on oppositesides of the tissue wherein the legs 144 can be pushed toward oneanother to compress the tissue positioned between the legs 144. Thejoint 143 can be configured to permit the angled portions 141 of thebase 142, and the legs 144 extending therefrom, to deform inwardly. Invarious circumstances, the clip 140 can be configured to yield, ordeform plastically, when the clip 140 is sufficiently compressed,although some amount of elastic deformation, or spring-back, may occurwithin the deformed clip 140.

Referring now to FIGS. 1 and 2, the clip applier 100 can include a shaft110, an end effector 120, and a replaceable clip cartridge, or magazine,130. Referring to FIGS. 14-16, the clip cartridge 130 can comprise ahousing 132 and a plurality of clips 140 positioned within the housing132. The housing 132 can define a storage chamber 134 in which the clips140 can be stacked. The storage chamber 134 can comprise sidewalls whichextend around, or at least substantially around, the perimeter of theclips 140. Referring again to FIG. 13, each clip 140 can compriseopposing faces, such as a top face 145 and a bottom face 146 on oppositesides of the clip 140 wherein, when the clips 140 are stacked in thehousing 132, the top face 145 of a clip 140 can be positioned againstthe bottom face 146 of an adjacent clip 140 and wherein the bottom face146 of the clip 140 can be positioned against the top face 145 ofanother adjacent clip 140. In various circumstances, the bottom faces146 of the clips 140 can face downwardly toward one or more supportshelves, or platforms, 135 defined in the housing 132 while the topfaces 145 of the clips 140 can face upwardly away from the supportshelves 135. The top faces 145 and the bottom faces 146 of the clips 140may be identical, or at least substantially identical, in some cases,while, in other cases, the top faces 145 and the bottom faces 146 may bedifferent. The stack of clips 140 depicted in FIGS. 14-16 comprises fiveclips 140, for example; however, other embodiments are envisioned inwhich the stack of clips 140 can include more than five clips 140 orless than five clips 140. In any event, the clip cartridge 130 canfurther comprise at least one biasing member, such as biasing member136, for example, positioned intermediate the housing 132 and the topclip 140 in the stack of clips 140. As described in greater detailbelow, the biasing member 136 can be configured to bias the bottom clip140 in the stack of clips 140 or, more particularly, the bottom face 146of the bottom clip 140, against the support shelves 135 defined in thehousing 132. The biasing member 136 can comprise a spring, and/or anysuitable compressed elastic element, for example, which can beconfigured to apply a biasing force to the clips 140, or at least applya biasing force to the top clip 140 which is transmitted downwardlythrough the stack of clips 140.

When a clip 140 is positioned against the support shelves 135 asdescribed above, the clip 140 can be supported in a firing position inwhich the clip 140 can be advanced and ejected from the cartridge 130.In various circumstances, the support shelves 135 can define at least aportion of a firing chamber 149 in which the clips 140 can besequentially positioned in the firing position. In some cases, thefiring chamber 149 can be entirely defined within the cartridge 130 or,in other cases, the firing chamber 149 can be defined within and/orbetween the shaft 110 and the cartridge 130. In any event, as describedin greater detail further below, the clip applier 100 can comprise afiring drive which can advance a firing member into the cartridge 130and push the clip 140 from its firing position positioned against thesupport shelves 135 to a fired position in which it is received withinthe end effector 120 of the clip applier 100. Referring primarily toFIGS. 14-16, the housing 132 of the cartridge 130 can comprise aproximal opening, or window, 133 which can be aligned, or at leastsubstantially aligned, with the support shelves 135 such that the firingmember can enter into the cartridge 130 through the proximal opening 133and advance a clip 140 distally out of the cartridge 130. In at leastone such embodiment, the housing 132 can further comprise a distal, ordischarge, opening, or window, 137 which is also aligned with thesupport shelves 135 such that the clip 140 can be advanced, or fired,distally along a firing axis 139 extending through the proximal opening133, the firing chamber 149, and the distal opening 137, for example.

In order to advance a clip 140 out of the cartridge 130, further to theabove, the firing member of the firing drive can be advanced into to thecartridge housing 132 and, in various circumstances, into the firingchamber 149. As disclosed in greater detail further below, the firingmember can pass entirely through the cartridge 130 in order to advancethe clip 140 into its fired position within the end effector 120. Afterthe clip 140 positioned in the firing chamber 149 has been advanceddistally by the firing member, as outlined above, the firing member canbe retracted sufficiently such that the biasing member 136 can positionanother clip 140 against the support shelves 135. In variouscircumstances, the biasing member 136 can bias a clip 140 against thefiring member while the firing member is positioned within the housing132. Such a clip 140 can be referred to as a queued clip. After thefiring member has been sufficiently retracted and slid out fromunderneath the queued clip 140, the biasing member 136 can then bias theclip 140 against the support shelves 135 where it is staged for the nextstroke of the reciprocating firing member. Referring primarily to FIGS.2 and 14-16, the cartridge 130 can be configured to supply the clips 140to the firing chamber 149 along a predetermined path, such as supplyaxis 138, for example. The supply axis 138 can be transverse to thefiring axis 139 such that the clips 140 are fed into the firing chamber149 in a direction which is different than the direction in which thefiring member passes through the firing chamber 149. In at least onesuch embodiment, the supply axis 138 can be perpendicular, or at leastsubstantially perpendicular, to the firing axis 139, for example.

Referring again to FIG. 2, the shaft 110 can comprise a cartridge, ormagazine, aperture 131 which can be sized and configured to receive aclip cartridge 130, for example, therein. The cartridge aperture 131 canbe sized and configured such that the housing 132 of the cartridge 130is closely received within the cartridge aperture 131. The sidewallswhich define the cartridge aperture 131 can limit, or at leastsubstantially limit, the lateral movement of the cartridge 130 relativeto the shaft 110. The shaft 110 and/or the cartridge 130 can furthercomprise one or more locks which can be configured to releasably holdthe cartridge 130 in the cartridge aperture 131. As illustrated in FIG.2, the cartridge 130 can be loaded into the cartridge aperture 131 alongan axis which is, in at least one embodiment, parallel to or collinearwith the supply axis 138. As also illustrated in FIG. 2, the shaft 110can further comprise a pad or seat 118 extending from the sidewall 111of the shaft 110 wherein the pad 118 can be configured to be receivedwithin and/or engaged with the housing 132 of the cartridge 130. The pad118 can be sized and configured to be closely received within a recess148 defined in the cartridge housing such that the pad 118 can limit, orat least substantially limit, the lateral movement of the cartridge 130relative to the shaft 110. The pad 118 can be sized and configured toalign the cartridge 130 within the shaft 110 and/or support thecartridge housing 132.

Once the clip cartridge 130 has been positioned and seated within theshaft aperture 131, referring now to FIGS. 5 and 6, a firing drive 160of the clip applier 100 can be actuated to advance the clips 140 fromthe clip cartridge 130 as described above. The firing drive 160 cancomprise a rotary drive input such as a drive screw 161, for example,and a displaceable firing nut 163 operably engaged with the drive screw161. The drive screw 161 can comprise at least one drive thread 162which can be threadably engaged with a threaded aperture extendingthrough the firing nut 163. In various embodiments, the clip applier 100can further include an electric motor, for example, operably coupledwith the drive screw 161. In various instances, the drive screw 161 canbe operably coupled with the motor of a surgical instrument systemcomprising a hand-held instrument or a robotic arm, for example. In anyevent, the movement of the firing nut 163 within the shaft 110 can beconstrained such that the firing nut 163 moves along a longitudinal axis164 when the drive screw 161 is rotated about the longitudinal axis 164by the motor. For instance, when the drive screw 161 is rotated in afirst direction by the motor, the drive screw 161 can advance the firingnut 163 distally toward the end effector 120, as illustrated in FIG. 6.When the drive screw 161 is rotated in a direction opposite the firstdirection by the motor, the drive screw 161 can retract the firing nut163 proximally away from the end effector 120. The shaft 110 cancomprise one or more bearings which can be configured to rotatablysupport the drive screw 161. For instance, a bearing 159 can beconfigured to rotatably support the distal end of the drive screw 161,for example, as illustrated in FIGS. 5 and 6.

The firing drive 160 can further comprise a firing member 165 extendingfrom the firing nut 163 which can be advanced distally and retractedproximally with the firing nut 163, as described in greater detailfurther below. Upon comparing FIGS. 5 and 6, the reader will note thatthe firing nut 163 and the firing member 165 have been advanced from aproximal, unfired position, illustrated in FIG. 5, to a distal, firedposition, illustrated in FIG. 6, in which the firing member 165 hasadvanced a clip 140 from the clip cartridge 130 into the end effector120. Referring primarily to FIG. 5, the clip cartridge 130 isillustrated as comprising a plurality of clips 140 stored thereinwherein one of the clips 140 is positioned in a firing position, asdescribed above. As illustrated in FIGS. 5 and 6, the firing member 165can include a distal portion 166 which can be advanced into the staplecartridge 130 along a firing axis 167 and engage the clip 140 positionedin the firing position when the firing member 165 and the firing nut 163are advanced distally. In some cases, the firing member 165 can comprisea linear member while, in other cases, the distal end 166 of the firingmember 165 can extend upwardly from the firing member 165, for example.Further to the above, the firing member 165 can advance the clip 140distally out of the clip cartridge 130 along the firing axis 167 andinto a receiving cavity 122 defined in the end effector 120.

In various cases, the firing member 165 can be attached to and extenddistally from the firing nut 163 while, in other cases, the firingmember 165 and the firing nut 163 can be operably connected to oneanother by a firing actuator 168. The firing actuator 168 can bepivotably mounted to the firing member 165 at a pivot 169 and caninclude a distal arm 170 a and a proximal arm 170 b which can be engagedwith a longitudinal slot 113 defined in the housing 112 of the shaft110. In at least one such embodiment, each of the arms 170 a, 170 b caninclude a projection, such as projections 171 a and 171 b, respectively,extending therefrom which can be configured to slide within thelongitudinal slot 113. Further to the above, the firing nut 163 canfurther include a firing pin 172 extending therefrom which can beconfigured to engage the distal arm 170 a in order to advance theactuator 168 and the firing member 165 distally, as described above. Inuse, referring again to the progression illustrated in FIGS. 5 and 6,the firing nut 163 can be advanced distally by the drive screw 161wherein the firing pin 172, which is positioned intermediate the distalarm 170 a and the proximal arm 170 b, can contact the distal arm 170 aand drive the actuator 168 and the firing member 165 distally. As theactuator 168 is advanced distally, the actuator 168 may be preventedfrom rotating about the pivot pin 169 as one or both of the projections171 a and 171 b sliding in the shaft slot 113 can be prevented frombeing moved laterally relative to the longitudinal shaft slot 113 untilthe actuator 168 reaches the position illustrated in FIG. 6.

When the actuator 168 has reached the position illustrated in FIG. 6,the distal projection 171 a can enter into a distal slot portion 114 ofthe longitudinal slot 113 which can be configured to pivot the actuator168 downwardly, or permit the actuator 168 to be pivoted downwardly, asillustrated in FIG. 9. In at least one such embodiment, the distalprojection 171 a can come into contact with the sidewall of the distalslot portion 114 which can guide the distal projection 171 a downwardlyand pivot the actuator 168 about the pivot 169 as the actuator 168 isadvanced forward by the firing nut 163. In such a pivoted position, thefiring pin 172 extending from the firing nut 163 may no longer beengaged with the distal arm 170 a of the actuator 168 wherein,subsequently, the firing nut 163 may move distally independently of theactuator 168 thereby leaving behind the actuator 168 and the firingmember 165. Stated another way, the distal end 114 of the longitudinalshaft slot 113 may deactivate the firing member 165 wherein, at suchpoint, the position of the firing member 165 may represent thefully-fired or distal-most position of the firing member 165. In such aposition, the clip 140 has been fully advanced into the receivingcavity, or receiver, 122. Furthermore, in such a position, the next clip140 to be advanced into the receiving cavity 122 may be biased againstthe top surface of the firing member 165, further to the above.

Once a clip 140 has been positioned within the receiving cavity 122,further to the above, the clip 140 can be deformed by a crimping drive180, for example. Referring now to FIGS. 3 and 4, the end effector 120of the clip applier 100 can further comprise a first jaw 123 a and asecond jaw 123 b wherein the first jaw 123 a and the second jaw 123 bcan at least partially define the receiving chamber 122. As illustratedin FIGS. 3 and 4, the first jaw 123 a can comprise a first channel 124 aand the second jaw 123 b can comprise a second channel 124 b which caneach be configured to receive and support at least a portion of a clip140 therein. The first jaw 123 a can be pivotably coupled to a frame 111of the shaft 110 by a pin 125 a and the second jaw 123 b can bepivotably coupled to the frame 111 by a pin 125 b. In use, the crimpingdrive 180 can be configured to rotate the first jaw 123 a toward thesecond jaw 123 b and/or rotate the second jaw 123 b toward the first jaw123 a in order to compress the clip 140 positioned therebetween. In atleast one such embodiment, the crimping drive 180 can comprise a camactuator 181 which can be configured to engage a first cam surface 126 adefined on the first jaw 123 a and a second cam surface 126 b on thesecond jaw 123 b in order to pivot the first jaw 123 a and the secondjaw 123 b toward one another. The cam actuator 181 can comprise a collarwhich at least partially surrounds the first jaw 123 a and the secondjaw 123 b. In at least one such embodiment, the collar can comprise aninner cam surface 182 which can be contoured to contact the cam surfaces126 a, 126 b of the jaws 123 a, 123 b and drive them inwardly toward oneanother. In various circumstances, the clip 140 positioned within thereceiving chamber 122 defined in the end effector 120 can be positionedrelative to tissue before the crimping drive 180 is actuated. In somecircumstances, the crimping drive 180 can be at least partially actuatedprior to positioning the clip 140 relative to the tissue in order to atleast partially compress the clip 140. In certain instances, the clip140 and the receiving chamber 122 can be sized and configured such thatthe clip 140 can be biased or flexed inwardly when the end effector 120is in its unactuated state, as illustrated in FIG. 3. In variousinstances, the crimping first jaw 123 a and the second jaw 123 b can beactuated to elastically crimp and/or permanently crimp the clip 140positioned therebetween.

Further to the above, the firing nut 163 can be configured to actuatethe crimping drive 180. More particularly, referring now to FIG. 7, thecrimping drive 180 can comprise a crimping actuator 188 operably coupledwith the cam actuator 181 wherein the crimping actuator 188 can beselectively engaged by the firing nut 163 as the firing nut 163 isadvanced distally as described above. In at least one such embodiment,the firing nut 163 can further comprise a second firing pin, such asfiring pin 184, for example, extending therefrom which can be configuredto engage the crimping actuator 188 as the firing nut 163 is advancingthe firing actuator 168. Referring again to FIG. 7, the crimpingactuator 188 is positioned in an unactuated position and, when thefiring nut 163 is advanced sufficiently to engage a distal arm 190 a ofthe crimping actuator 188, the firing nut 163 can rotate the crimpingactuator 188 upwardly into an actuated position as illustrated in FIG.8. As also illustrated in FIG. 8, the distal arm 190 a and a proximalarm 190 b can each comprise a projection, such as projections 191 a and191 b, respectively, extending therefrom which can be positioned withina second longitudinal slot defined in shaft 110, such as slot 115, forexample. As the crimping actuator 188 is rotated upwardly from itsunactuated position about a pivot 189, the projections 191 a and 191 bcan move from the proximal curved end 116 of the longitudinal slot 115into a portion of the longitudinal slot 115 which is substantiallylinear. Similar to the above, the sidewalls of the longitudinal slot 115can be configured to confine the movement of the crimping actuator 188along a longitudinal path and can be configured to limit or prevent therotation of the crimping actuator 188 once the crimping actuator 188 hasbeen rotated upwardly into an at least partially actuated position, asdiscussed above. As the reader will understand, the firing pin 172 ofthe firing drive 160 and the firing pin 184 of the crimping drive 180both extend from the firing nut 163. For the sake of expediency anddemonstration, the firing pins 172 and 184 are illustrated as extendingfrom the same side of the firing nut 163; however, it is envisioned thatthe firing pin 172 can extend from a first lateral side of the firingnut 163 while the firing pin 184 can extend from the other lateral sideof the firing nut 163. In such circumstances, the firing actuator 168can be positioned alongside the first lateral side of the drive screw161 and the crimping actuator 188 can be positioned alongside theopposite lateral side of the drive screw 161. Correspondingly, thelongitudinal slot 113 can be defined in a first lateral side of theshaft housing 112 while the longitudinal slot 115 can be defined in theopposite lateral side of the shaft housing 112.

Further to the above, the cam actuator 181 can be operably coupled withcrimping actuator 188 such that, when the crimping actuator 188 isadvanced distally by the firing nut 163, the cam actuator 181 can beadvanced distally, as illustrated in FIGS. 8 and 10, until the distalprojection 191 a extending from the distal arm 190 a reaches the distalend 117 of the longitudinal slot 115. In such a distal position, the camactuator 181 may be in a fully advanced position and the clip 140positioned within the receiving chamber 122 can be in a fully deformedor crimped configuration. Thereafter, the cam actuator 181 can beretracted and the end effector 120 can be reopened. More particularly,the drive screw 161 can be rotated in an opposite direction in order tomove the firing nut 163 proximally and retract the cam actuator 181wherein, in certain instances, the end effector 120 can further includea biasing member which can be configured to bias the first jaw 123 andthe second jaw 123 b from the closed, or fired, position illustrated inFIG. 4 into the open, or unfired, position illustrated in FIG. 3. As thefiring nut 163 is retracted from its position illustrated in FIG. 10,the firing pin 184 extending from the firing nut 163 can engage theproximal arm 190 b of the crimping actuator 188 and move the crimpingactuator 188, and the cam actuator 181 extending therefrom, proximallyas illustrated in FIG. 12. Similar to the above, the proximal projection191 b extending from the proximal arm 190 b of the crimping actuator 188can be configured to contact the sidewall of the curved proximal end 116wherein the sidewall can guide the crimping actuator 188 downwardly androtate the crimping actuator 188 about the pivot 189. At such point, thefiring pin 184 may no longer be engaged with the crimping actuator 188,the cam actuator 181 may be fully retracted, and the firing nut 163 maycontinue to be retracted proximally relative to the crimping actuator188.

Further to the above, referring now to FIG. 11, the firing nut 163 canbe configured to re-engage the firing actuator 168 as the firing nut 163is being retracted proximally. As discussed above, the firing actuator168 is rotated downwardly when the firing actuator 168 reaches thedistal end 114 of the longitudinal slot 113 and, as a result, the firingactuator 168 may still be in its downwardly rotated position when thefiring nut 163 is retracted proximally to re-engage the firing actuator168. As illustrated in FIG. 11, the firing pin 172 extending from thefiring nut 163 can engage the proximal arm 170 b of the firing actuator168 and, as the firing nut 163 is further retracted, the firing nut 163can rotate the firing actuator 168 upwardly such that the projections171 a and 171 b extending from the arms 170 a and 170 b, respectively,can re-enter the longitudinal portion of the longitudinal slot 113.Thereafter, the firing nut 163 and can be retracted until the firingactuator 168 and the firing member 165 extending therefrom have beenreturned to their starting, or unfired, positions illustrated in FIG. 5.In such circumstances, the firing member 165 can be withdrawn from theclip cartridge 130 as the firing member 165 is retracted proximally bythe firing nut 163 such that a new clip 140 can be biased into thefiring chamber of the clip cartridge 130 by the biasing member 136. Oncethe firing member 165 and the firing actuator 168 have been retracted totheir starting positions and the next clip 140 has been positionedwithin the firing chamber, the firing drive 160 can be actuated onceagain in order to move the firing nut 163 and the firing member 165distally to advance the next clip 140 into the end effector 120.Likewise, the firing nut 163 can re-actuate the crimping drive 180 asthe firing nut 163 is moved distally once again in order to deform thenext clip 140. Thereafter, the firing nut 163 can retracted in order tore-set the crimping drive 180 and the firing drive 160 once again. Thisprocess can be repeated until a sufficient number of clips 140 have beenapplied to the targeted tissue and/or until the clips 140 containedwithin the clip cartridge 130 have been depleted. In the event thatadditional clips 140 are needed, the expended clip cartridge 130 can beremoved from the shaft 110 and a replacement clip cartridge 130containing additional clips 140 can be inserted into the shaft 110. Insome circumstances, an at least partially depleted clip cartridge 130can be replaced with an identical, or at least nearly identical,replacement clip cartridge 130 while, in other circumstances, the clipcartridge 130 can be replaced with a clip cartridge having more than orless than five clips 140 contained therein and/or a clip cartridgehaving clips other than clips 140 contained therein, for example.

Referring again to FIGS. 6-9, the firing nut 163 of the illustratedembodiment can be configured to become disengaged from the firingactuator 168 at the same time that the firing nut 163 becomes engagedwith the crimping actuator 188. Stated another way, the firing drive 160can be deactivated at the same time that the crimping drive 180 isactivated. In various circumstances, such timing can be achieved whenthe distal end 114 of the longitudinal slot 113 is aligned, or at leastsubstantially aligned, with the proximal end 116 of the secondlongitudinal slot 115, for example. In the illustrated embodiment and/orany other suitable embodiment, a lag can exist between the deactivationof the firing drive 160 and the activation of the crimping drive 180.Such a lag between the end of the firing stroke of the firing member 165and the beginning of the firing stroke of the cam actuator 181 can becreated, in some circumstances, to assure that the clip 140 has beenpositioned in its fully-seated position within the receiving chamber 122before the clip 140 is deformed by the cam actuator 181. In variouscircumstances, such a lag can be created when the distal end 114 of thelongitudinal slot 113 is positioned proximally with respect to theproximal end 116 of the second longitudinal slot 115, for example. Inthe illustrated embodiment and/or any other suitable embodiment, thedeactivation of the firing drive 160 may occur after the activation ofthe crimping drive 180. Such an overlap between the end of the firingstroke of the firing member 165 and the beginning of the firing strokeof the cam actuator 181 can be created, in some circumstances, to applyat least some inward pressure on the clip 140 as it is moved into itsfully-seated position within the receiving chamber 122 so as to reduceor eliminate relative movement between the clip 140 and the sidewalls ofthe receiving chamber 122, for example. In various circumstances, suchan overlap can be created when the distal end 114 of the longitudinalslot 113 is positioned distally with respect to the proximal end 116 ofthe second longitudinal slot 115, for example.

In the illustrated embodiment of FIG. 1 and/or any other suitableembodiment, turning now to FIG. 17, a clip cartridge, such as clipcartridge 230, for example, can comprise a pusher plate 248 positionedintermediate the biasing member 136 and the top-most clip 140 stackedwithin the clip cartridge 230. The pusher plate 248 can be rigid, or atleast substantially rigid, and can comprise a first bearing surfaceagainst which the biasing member 136 can apply a biasing force. Thepusher plate 248 can also comprise a second bearing surface which cantransmit the biasing force to the top surface 145 of the top-most clip140. The pusher plate 248 can be comprised of a sheet of stainless steelmaterial, for example, although the pusher plate 248 can comprise anysuitable shape and can be comprised of any suitable material. In certaininstances, the pusher plate 248 may not be attached to the biasingmember 136 while, in other instances, the pusher plate 248 can beaffixed to the biasing member 136 such that the pusher plate 248 doesnot become dislodged from the cartridge housing 132. In variouscircumstances, the pusher plate 248 can be sized and configured suchthat it cannot pass through the proximal opening 133 and/or the distalopening 137 defined in the cartridge housing 132.

In the illustrated embodiment of FIG. 1 and/or any other suitableembodiment, turning now to FIGS. 18 and 19, a clip cartridge, such asclip cartridge 330, for example, can comprise a lockout member which canbe positioned within the firing chamber 149 of the clip cartridge 330after all of the clips 140 contained within the clip cartridge 330 havebeen ejected from the cartridge 330. The lockout member can comprise alockout plate 348 which can be positioned intermediate the biasingmember 136 and the top surface 145 of the top-most clip 140 containedwithin the clip cartridge 330. In use, further to the above, the clips140 can be sequentially positioned in the firing chamber 149 of the clipcartridge 130 and then advanced distally out of the clip housing 132wherein, after the last clip 140 has been advanced out of the cliphousing 132 and the firing member 165 has been withdrawn from the clipcartridge 130, the biasing member 136 can bias the lockout plate 348against the shelves 135. In such a position, the lockout plate 348 canbe aligned with the proximal opening 133 and the distal opening 137 suchthat the firing member 165 cannot enter, or at least substantiallyenter, the clip cartridge 130. In such circumstances, the lockout plate348 can block the firing member 165 from entering into and passingthrough the housing 132 and, as a result, prevent the inadvertent firingof the clip applier 100 after the clip cartridge 130 has run out ofclips. In the event that the operator of the clip applier 100 were toactuate the firing drive 160 and attempt to advance the firing member165 into the spent clip cartridge 130, the firing member 165 wouldcontact and abut the lockout plate 348 wherein, in such circumstances, acompressive load can be created within the firing member 165. The clipapplier 100 can further include a clutch which can be configured to slipand operably disconnect the motor from the drive screw 161 when thecompressive load created within the firing member 165 exceeds a certainor predetermined amount. In addition to or in lieu of a clutch, themotor and/or motor controller of the clip applier 100 which operates thefiring drive 160, for example, can comprise a load sensor configured todetect the load generated within the firing member 165 and, when theload created within the firing member 165 exceeds a certain orpredetermined amount, the voltage and/or current supplied to the motorcan be switched off and/or reduced. In any event, the lockout plate 348can be sized and configured such that the lockout plate 348 cannot bedislodged through the distal opening 137 and/or the proximal opening 133when the firing member 165 contacts the lockout plate 348. In order touse the clip applier 100 once again, the operator of the clip applier100 can remove the spent cartridge 330 from the shaft 110 and insert anew clip cartridge 330, for example, into the shaft 110. At such point,a clip 140 may be positioned within the firing chamber 149 of the newclip cartridge 330 and the firing member 165 can be advanced distallyinto the new clip cartridge 330 to deploy the clip 140 as describedabove.

In the illustrated embodiment of FIG. 1 and/or any other suitableembodiment, referring now to FIGS. 20 and 21, a clip cartridge, such asclip cartridge 430, for example, can comprise guides which can beconfigured to limit or confine the movement of a lockout member withinthe clip cartridge 430. Similar to the above, the lockout member cancomprise a lockout plate 448, for example, which can be positionedintermediate the biasing member 136 and the top surface 145 of thetop-most clip 140 contained within the housing 432 of the clip cartridge430. In use, similar to the above, the lockout plate 448 can beprogressively pushed downwardly into the firing chamber 149 as the clips140 are sequentially ejected from the clip cartridge 430. The lockoutplate 448 can be sized and configured such that it is closely receivedwithin the cartridge housing 432 and such that relative lateral movementbetween the lockout plate 448 and the housing 432 can be limited inorder to reduce, or prevent, the possibility of the lockout plate 448becoming misaligned within the clip cartridge 430. In the event that thelockout plate 448 were to become misaligned within the clip cartridge430, the lockout plate 448 may bind within the housing 432 and preventthe biasing member 136 from applying an appropriate biasing force to thestack of clips 140, for example. As illustrated in FIGS. 20 and 21, thelockout plate 438 can further comprise guide members 447 extendingtherefrom which can be received within guide slots 446 defined in thecartridge housing 432. The guide members 447 and the guide slots 446 canbe sized and configured such that the guide members 447 are closelyreceived within the guide slots 446 and such that relative lateralmovement between the lockout plate 438 and the cartridge housing 432 canbe limited. Each of the guide slots 446 can be defined by opposingsidewalls 445 which can define a distance therebetween which is equal toor slightly larger than the width of the guide member 447 positionedtherein such that the guide member 447 can slide between the opposingsidewalls 445 between the top 443 and the bottom 444 of the guide slot446. Thus, while the guide members 447 and the guide slots 446 can beconfigured to limit lateral movement therebetween, as outlined above,the guide members 447 and the guide slots 446 can be configured topermit relative movement between the lockout plate 438 and the cartridgehousing 432 along a predetermined path parallel to or collinear with thesupply axis 138, for example. When the lockout plate 438 is pushed intothe firing chamber 149 by the biasing member 136, the lockout plate 438can inhibit the advancement of the firing member 165 and the operationof the clip applier 100, as outlined above, until the spent clipcartridge 430 is replaced with another suitable clip cartridge.

In the illustrated embodiment of FIG. 1 and/or any other suitableembodiment, as discussed above, the drive screw 161 can be rotated in afirst direction to advance the firing nut 163 distally and rotated in asecond, or reverse, direction to retract the firing nut 163 proximally.In order to rotate the drive screw 161 in the first and seconddirections, the electric motor operably coupled with the drive screw 161can be operated in corresponding first and second directions. In theillustrated embodiment of FIG. 1 and/or any other suitable embodiment, aclip applier can utilize a motor which is operated in only a firstdirection wherein the rotation of the motor in such a single directioncan be utilized to advance a firing nut distally and retract the firingnut proximally. Turning now to FIGS. 22-26, the output of an electricmotor can be transmitted to a drive system 560 via a transmission system550. The transmission system 550 can comprise an input shaft 552 whichis operated in a single direction wherein the transmission system 550can be switchable or shiftable between a first state, or configuration,in which the transmission system 550 rotates a drive screw 561 of thedrive system 560 in a first direction and a second state, ofconfiguration, in which the transmission system 550 rotates the drivescrew 561 in a second, or opposite, direction. The first state of thetransmission system 550 is depicted in FIGS. 22-24 and the second stateof the transmission system 550 is depicted in FIGS. 25 and 26.

Referring again to FIGS. 22-24, the input shaft 552 can comprise aninput gear 551 mounted thereto which is operably coupled, or meshinglyengaged, with a shifter gear 553 such that the rotation of the inputshaft 552 is transmitted to the shifter gear 553. With regard to all ofthe gears discussed herein, gears which are operably coupled ormeshingly engaged with one another can comprise any suitable arrangementof teeth, for example, which can transmit the rotation of one gear tothe other. When the input shaft 552 is rotated in the first direction,the shifter gear 553 is rotated in the second, or opposite, direction.In the first state of the transmission system, the shifter gear 553 isin a first position in which the shifter gear 553 is operably coupledwith an intermediate gear 554 wherein, when the shifter gear 553 isrotated in the second direction by the input gear 551, as discussedabove, the intermediate gear 554 is rotated in the first direction.Although not illustrated, the intermediate gear 554 can be rotatablysupported within the shaft 110 of the clip applier 100, for example. Theintermediate gear 554 can also be operably coupled with an output gear555 mounted to the drive screw 561 such that the rotation of theintermediate gear 554 can be transmitted to the output gear 555. Whenthe intermediate gear 554 is driven in the first direction by theshifter gear 553, as described above, the intermediate gear 554 candrive the output gear 555 and the drive screw 561 in the seconddirection. Similar to the above, the firing nut 563 can be operablycoupled with the drive screw 561 and suitably constrained within theshaft 110 such that, when the drive screw 561 is rotated in the seconddirection, the firing nut 563 is advanced distally as indicated by thearrow D.

Similar to the above, the firing nut 563 can be advanced to itsdistal-most position, illustrated in FIG. 24, in order to advance a clip140 from the clip cartridge 130 into the end effector 120 and crimp theclip 140 as described above. As illustrated in FIGS. 23 and 24, thefiring nut 563 can further comprise a cam bar 569 extending therefromwhich can be configured to shift the transmission system 550 from itsfirst state to its second state. Upon comparing FIG. 24 and FIG. 25, thereader will note that the shifter gear 553 is movable between a firstposition in which the transmission system 550 is in its first state anda second position in which the transmission system 550 is in its secondstate. More particularly, the shifter gear 553 is mounted to a shifter556 which is rotatable about the input shaft 552 such that the shiftergear 553 can be rotated from its first position in which the shiftergear 553 is operably engaged with the input gear 551 and theintermediate gear 554 and its second position in which the shifter gear553 is operably disengaged from the intermediate gear 554. Although theshifter gear 553 is operably disengaged from the intermediate gear 554when the shifter gear 553 is in its second position, the shifter gear553 can be operably coupled with the input gear 551 and the output gear555 in order to transmit rotary motion from the input shaft 552 to thedrive screw 561. As illustrated in FIGS. 24 and 25, the shifter 556 cancomprise a central aperture through which the input shaft 552 canextend; however, the shifter 556 may not be operably engaged with theinput shaft 552 and, as a result, the rotation of the input shaft 552may not rotate the shifter 556 and, likewise, the rotation of theshifter 556 may not rotate the input shaft 552. In any event, theshifter 556 can further comprise a cam follower 558 extending therefromwhich can be engaged by a cam 568 defined on the cam bar 569 as thefiring nut 563 is advanced distally. When the cam 568 engages the camfollower 558, the cam 568 can rotate the shifter 556 and the shiftergear 553 between its first position and its second position as describedabove.

When the shifter gear 553 is in its second position and the transmissionsystem 550 is in its second state, as described above, the input shaft552 and the drive screw 561 can both be rotated in the first direction.More particularly, the input shaft 552, when rotated in the firstdirection, can rotate the input gear 551 in the first direction and, asthe shifter gear 553 is directly engaged with the input gear 551, theshifter gear 553 will be rotated in the second direction. The readerwill note that the shifter gear 553 rotates in the second direction whenthe transmission system 550 is in its second state as compared to thefirst, or opposite, direction when the transmission system 550 is in itsfirst state. Upon comparing FIGS. 24 and 25, further to the above, thereader will appreciate that the intermediate gear 554 is no longeroperably positioned intermediate the input gear 551 and the shifter gear553 when the transmission system 550 is in its second state therebyaccounting for the different directions of rotation. As the shifter gear553 is operably engaged with the input gear 551 and the output gear 555when the shifter gear 553 is in its second position, the shifter gear553 can rotate the output gear 555, and the drive screw 561 coupled tothe output gear 555, in the first direction. When the drive screw 561 isrotated in the first direction, as illustrated in FIGS. 25 and 26, thefiring nut 563 can be retracted proximally to permit the end effector120 to be reopened and to retract the firing member 165. Referringprimarily to FIG. 26, the firing nut 563 can further comprise a secondcam bar 567 extending therefrom comprising a cam 566 which can beconfigured to contact the cam follower 558 of the shifter 556 as thefiring nut 563 is retracted proximally into its fully-retractedposition. In such circumstances, the cam 566 can push the shifter 556back into its first position and into operative engagement with theintermediate gear 554 such that the transmission system 550 can be resetinto its first state and the clip applier 100 can be actuated onceagain.

As discussed above, the firing drive of the clip applier 100 can beoperated by a surgical instrument system comprising an electric motor. Arobotic surgical instrument system 20 is illustrated in FIG. 27 and cancomprise a plurality of movable arms 30. Each arm 30 can comprise anactuator module 32 comprising an electric motor configured to supply therotary motion to the shaft 110 of a clip applier 100, and/or any othersuitable surgical instrument. Referring now to FIG. 28, an end effector620 may be selectively engageable with and disengageable from anactuator shaft 610 of a clip applier wherein the end effector 620 cancomprise a proximal end 621 which can be coupled to a distal end 611 ofthe shaft 610. The proximal end 621 of the end effector 620 can comprisean outer housing 629, a frame extending through the outer housing 629,an outer drive shaft extending through the frame, and an inner driveshaft extending through the outer drive shaft. Similarly, the distal end611 of the shaft 610 can comprise an outer housing 619, a frame 663extending through the outer housing 619, an outer drive shaft 662extending through the frame 663, and an inner drive shaft 661 extendingthrough the outer drive shaft 662. With regard to the distal end 611 ofthe shaft 610, the frame 663, the outer drive shaft 662, and the innerdrive shaft 661 can each comprise a portion of a tongue connector 613extending therefrom and a portion of a connector groove 612 definedtherein, wherein the tongue connector 613 can be configured to bereceived within a tongue groove 623 defined in the proximal end 621 ofthe end effector 620, and wherein the tongue groove 612 can beconfigured to receive a tongue connector 622 extending from the proximalend 621 of the end effector 620. Similar to the tongue connector 613which extends across the frame 663, the outer drive shaft 662, and theinner drive shaft 661 of the distal shaft end 611, the tongue connector622 can extend across the frame, the outer drive shaft, and the innerdrive shaft of the proximal end 621 of the end effector 620. Also,similar to the tongue groove 612 which extends across the frame 663, theouter drive shaft 662, and the inner drive shaft 661 of the distal shaftend 611, the tongue groove 623 can extend across the frame, the outerdrive shaft, and the inner drive shaft of the proximal end 621 of theend effector 620. In the configuration depicted in FIG. 28, the tongueconnector 622 of the end effector 620 can be slid laterally into thetongue groove 612 of the shaft 610 at the same time that the tongueconnector 613 of the shaft 610 is slid laterally into the tongue groove623 of the end effector 620. Owing to such assembly, the frame of theend effector 620 can be securely coupled to the frame 663 of the shaft610, the outer drive shaft of the end effector 620 can be operablycoupled to the outer drive shaft 662 of the shaft 110, and the innerdrive shaft of the end effector 620 can be operable coupled to the innerdrive shaft 661 of the shaft 110. The reader will note that the portionsof the tongue connector 612 are aligned with one another, the portionsof the tongue groove 613 are aligned with one another, the portions ofthe tongue groove 622 are aligned with one another, and the portions ofthe tongue connector 623 are aligned with one another when the endeffector 620 is assembled to the shaft 610. Once assembled, the outerdrive shaft 662 of the shaft 110 can rotate the outer drive shaft of theend effector 620, and the inner drive shaft 661 of the shaft 610 canrotate the inner drive shaft of the end effector 620. When the outerdrive shaft 662 and/or the inner drive shaft 661 are rotated, theportions of the tongue connector 612, the portions of the tongue groove613, the portions of the tongue groove 622, and the portions of thetongue connector 623 may no longer be aligned. In order to remove theend effector 620 from the shaft 610, the inner drive shaft 661 and/orthe outer drive shaft 662 can be rotated into one or more positions inwhich the tongue connectors 612 and 623 and the tongue grooves 613 and622 are sufficiently aligned.

Referring again to FIG. 28, the outer housing 619 of the shaft 610 canfurther comprise a stop 614 which can be configured to limit the lateralmovement of the end effector 620 as the end effector 620 is being slidtransversely onto the distal end 611 of the shaft 610. The stop 614 canprovide a datum from which the inner drive shaft of the end effector 620and the inner drive shaft 661 of the shaft 610 are aligned alonglongitudinal axis 615, the outer drive shaft of the end effector 620 andthe other drive shaft 662 of the shaft 610 are aligned alonglongitudinal axis 615, and/or the frame of the end effector 620 and theframe 663 of the shaft 610 are aligned along the longitudinal axis 615.Further to the above, the inner drive shaft 661 can extend into anactuator module 632 which can comprise an electric motor and/or geartrain 664 operably coupled with the inner drive shaft 661 configured torotate the inner drive shaft 661. Furthermore, the actuator module 632can comprise a second electric motor and gear train operably engagedwith the second drive shaft 662 configured to drive the second driveshaft 662. As described in greater detail below, a second electric motorcan be utilized to articulate the end effector 620. Also, further to theabove, the outer housing 619 and/or the frame 663 of the shaft 610 canfurther comprise a gear 617 mounted thereto which is operably engagedwith an electric motor and gear train 618 which can be configured torotate the shaft 610 and the end effector 620 about the longitudinalaxis 615. For instance, if the electric motor and gear train 618 areoperated in a first direction, the shaft 610 and the end effector 620can be rotated about the axis 615 in a clockwise direction while, if theelectric motor and gear train 618 are operated in a second direction,the shaft 610 and the end effector 620 can be rotated about the axis 615in a counter-clockwise direction in order to position and orient the endeffector 620.

As discussed above, the end effector 620 can be selectively attached toand detached from the shaft 610. The reader will note that theprinciples discussed in connection with the end effector 620 and shaft610 can be equally applied to the end effector 120 and the shaft 110 ofthe embodiment disclosed in FIG. 1, among others. That said, referringagain to FIG. 27, one of the robotic arms 30 can be selectively engagedwith an end effector 120 of a clip applier or, alternatively, any othersuitable end effector, such as the end effector of a surgical stapler,for example. In such circumstances, an end effector 120 can beselectively interchanged with another end effector and, as a result, asingle robotic arm 30 can be utilized to perform more than one function.Stated another way, the clip applier 100 can comprise a replaceableloading unit which can be replaced by, or interchanged with, anotherclip applier loading unit and/or any other suitable replaceable loadingunit. Turning now to FIG. 29, the end effector 120 and the shaft 110 ofthe clip applier 100 can be utilized with a surgical instrument systemcomprising a handle 700. The handle 700 can comprise an actuator 701which can be operated, or squeezed toward grip 702, in order to apply arotary motion to the drive screw 161 as described above. In some cases,the rotation of the actuator 701 can be mechanically transmitted to thedrive screw 161 while, in other cases, the actuator 701 can operate amotor operably coupled to the drive screw 161.

Further to the above, the end effector 120 and the shaft 110 of the clipapplier 100 can be aligned along a longitudinal axis of the clip applier100. Turning now to FIG. 30, the end effector 120 and/or the shaft 110can further comprise an articulation joint 101 which can be configuredto permit the end effector 120 to be articulated relative to thelongitudinal axis of the clip applier 100. The shaft 110 can comprise anouter housing, or frame portion, 119 which can comprise a proximal end102 and can comprise a distal portion of the articulation joint 101. Theproximal end 102 can comprise a spherical, or an at least substantiallyspherical, end 102, for example, which can be received within aspherical, or an at least substantially spherical, cavity 104 defined inan articulation joint member 103. The articulation joint member 103 canalso comprise a spherical, or at least substantially spherical, end 105,for example, which can be received within a spherical, or an at leastsubstantially spherical, cavity 107 defined in a shaft frame portion106. The proximal end 102 of the shaft 110 can be at least partiallycaptured within the cavity 104 such that the proximal end 102 cannot bereadily removed from the cavity 104. That said, the proximal end 102 andthe cavity 104 can be sized and configured to permit the proximal end102 to be rotated in any suitable direction within the cavity 104. Asalso illustrated in FIG. 30, the clip applier 100 can further comprisearticulation controls 108 a and 108 b, for example, which can extendthrough the articulation joint 101 and can comprise distal ends mountedwithin mounting apertures 109 a and 109 b, respectively, defined withinthe proximal end 102 of the shaft housing 119. In use, the articulationcontrols 108 a and 108 b can be pushed and/or pulled in order to movethe proximal end 102 within the cavity 104. Further to the above, theend 105 of the articulation joint member 103 can be at least partiallycaptured within the cavity 107 defined in the shaft frame portion 106such that the end 105 cannot be readily removed from the cavity 107.That said, the end 105 and the cavity 107 can be sized and configured topermit the end 105 to be rotated in any suitable direction within thecavity 107 when the shaft end 102 is pushed and/or pulled by theactuators 108 a and 108 b as described above.

Further to the above, referring again to FIG. 30, the drive screw 161can be rotated by an input shaft, such as input shaft 152, for example.The input shaft 152 can extend through an aperture 156 defined withinthe shaft frame portion 106, the articulation joint member 103, and theproximal end 102 of the shaft housing 119. The input shaft 152 cancomprise an input gear 151 mounted to the distal end thereof which canbe operably coupled with an output gear 155 mounted to the proximal endof the drive screw 161. In use, the input shaft 152 can be rotated bythe electric motor, described above, wherein the input shaft 152 canrotate the drive screw 161. As outlined above, the articulation joint101 can be configured to permit the end effector 120 and at least aportion of the shaft 110 to be articulated relative to a longitudinalaxis defined by the clip applier 100. In order to accommodate suchmovement, at least the portion of the input shaft 152 extending throughthe articulation joint 101 can be sufficiently flexible.

Turning now to FIGS. 31-34, the articulation actuators 108 a and 108 bcan be operated by an actuator module such as module 832, for example.Referring primarily to FIG. 31, the actuator module 832 can comprise arotatable articulation driver 833 which can be configured to push andpull the articulation actuators 108 a and 108 b. The articulation driver833 can comprise a cylindrical, or an at least substantiallycylindrical, collar 835 including an aperture 837 which can beconfigured to receive at least a portion of the shaft frame 106 thereinin order to rotatably support the collar 835. The articulation driver833 can further comprise an input gear portion 834 which can be operablycoupled with an electric motor and gear train 831 of the module 832wherein, when the electric motor and gear train 831 are actuated, thearticulation driver 833 can be rotated about the shaft frame 106.Referring primarily to FIGS. 32 and 34, the articulation driver 833 canfurther comprise two cam slots defined in the sidewall of the collaraperture 837, although the reader will note that only one cam slot 835 ais illustrated in the provided views. The cam slot 835 a is configuredto receive a cam follower 838 a extending from the articulation driver108 a wherein the cam follower 838 a is configured to slide within thecam slot 835 a. When the articulation driver 833 is rotated, the helicalcontour of the cam slot 835 a, for example, can be configured to pushthe cam follower 838 a distally or pull the cam follower 838 aproximally, depending on the direction in which the articulation driver833 is rotated. As a result of the proximal or distal movement of thecam follower 838 a, the cam actuator 108 a can be moved proximally ordistally, respectively. While not illustrated, the articulation driver108 b can comprise a cam follower, similar to the cam follower 838 a,which can be configured to slide within the other cam slot discussedabove. The other cam slot can be configured such that, when thearticulation actuator 108 a is driven distally by the articulationdriver 833 when the articulation driver 833 is rotated in a firstdirection, the articulation actuator 108 b can be pulled proximally.Similarly, the other cam slot can be configured such that, when thearticulation actuator 108 a is pulled proximally by the articulationdriver 833 when the articulation driver 833 is rotated in a seconddirection, the articulation actuator 108 b can be driven distally.Referring primarily to FIG. 32, the shaft frame portion 106 can compriseclearance slots 839 defined therein through which the cam followers canextend. Although the above features have been discussed in connectionwith an actuator module 832, such features could be used in connectionwith the other actuator modules disclosed herein.

FIGS. 35A, 35B, and 35C depict a clip applier 70100 in accordance withat least one embodiment. The clip applier 70100 is similar to the clipapplier 100 in many respects, most of which will not be repeated hereinfor the sake of brevity. Similar to the clip applier 100, the clipapplier 70100 comprises an end effector 70120, a shaft, a clipcartridge, and a firing member 70165. The clip cartridge comprises aplurality of clips 70140 removably stored therein. The end effector70120 comprise a first jaw 70123 a and a second jaw 70123 b wherein thefirst jaw 70123 a and the second jaw 70123 b at least partially define areceiving chamber 70122. Further, the first jaw 70123 a and the secondjaw 70123 b are pivotally coupled to the shaft by a pin 70125 such thatthe first jaw 70123 a and the second jaw 70123 b are movable relative toeach other between an open position (FIG. 35B) and a closed position(FIG. 35A). The first jaw 70123 a and the second jaw 70123 b are movablebetween the open position and the closed position by a crimping drive70180 (see FIGS. 36-38). Other embodiments are envisioned where thefirst jaw 70123 a and the second jaw 70123 b are pivotally coupled tothe shaft utilizing at least one pin similar to the first jaw 125 a andsecond jaw 125 b depicted in FIG. 1. The first jaw 70123 a and thesecond jaw 70123 b include pre-form features, such as protrusions 70126a and 70126 b which are discussed in further detail below.

In use, the firing member 70165 advances a clip 70140 from the clipcartridge onto the protrusions 70126 a and 70126 b as depicted in FIG.35A. In this position, the clip 70140 is in a pre-formed configuration.The width of the clip 70140 in the pre-formed configuration can be0.080″ preferably. When the first jaw 70123 a and the second jaw 70123 bare moved from the closed position to the open position, the protrusions70126 a and 70126 b expand the clip 70140 to an expanded configurationas depicted in FIG. 35B. The width of the clip 70140 in the expandedconfiguration can be 0.210″ preferably. During the transition of theclip 70140 from the pre-formed configuration to the expandedconfiguration, the firing member 70165 supports the backside of the clip70140. More specifically, the firing member 70165 includes angledsurfaces 70165 a and 70165 b which provide support for the backside ofthe clip 70140 as the clip 70140 expands. Further, as the clip 70140 isexpanded, the firing member 70165 can be advanced to allow the angledsurfaces 70165 a and 70165 b to continue to maintain contact against thebackside of the clip 70140 as the clip 70140 expands. Once in theexpanded configuration, the clip 70140 is advanced into the receivingchamber 70122 by the firing member 70165. The protrusions 70126 a and70126 b include angled portions which allow the clip 70140 to slide overthe protrusions 70126 a and 70126 b when the clip 70140 is advanced bythe firing member 70165. After the clip 70140 has been advanced into thereceiving chamber 70122, the firing member 70165 is retracted, and thecrimping drive 70180 is actuated to transition the first jaw 70123 a andthe second jaw 70123 b to the closed position depicted in FIG. 35A tocrimp the clip 70140 positioned in the receiving chamber 70122. Afterthe clip 70140 is crimped, another clip 70140 can be advanced onto theprotrusions 70126 a and 70126 b by the firing member 70165. When thefirst jaw 70123 a and the second jaw 70123 b are moved from the closedposition to the open position by the crimping drive 70180, the clip70140 that has been crimped in the receiving chamber 70122 will bereleased from the receiving chamber 70122 and the clip 70140 that wasadvanced onto the protrusions 70126 a and 70126 b will be expanded intoto the expanded configuration by the protrusions 70126 a and 70126 b ofthe first and second jaws 70123 a and 70123 b. Interaction between thecrimping drive 70180 and the first and second jaws 70123 a and 70123 bis discussed in further detail below.

FIGS. 36-38 depict the clip applier 70100 as described above. Inaddition, FIGS. 36-38 further depict the interaction between thecrimping drive 70180 and the first and second jaws 70123 a and 70123 b.The crimping drive 70180 comprises a first crimping drive pin 70180 aand a second crimping drive pin 70180 b protruding therefrom. The firstjaw 70123 a comprises a first jaw cam 70124 a extending therefrom andthe second jaw 70123 b comprises a second jaw cam 70124 b extendingtherefrom. In use, the crimping drive 70180 is movable between a fullyretracted position (FIG. 38), a home position (FIG. 37), and afully-fired position (FIG. 36). The fully-fired position can preferablybe 0.300″ distal to the home position. The fully retracted position canpreferably be 0.050″ proximal to the home position. Other embodimentsare envisioned with different distances between the home position, thefully retracted position, and the fully-fired position. The crimpingdrive 70180 cammingly engages outer surfaces of the first jaw 70123 aand the second jaw 70123 b to transition the first jaw 70123 a and thesecond jaw 70123 b to a closed position when the crimping drive 70180 ismoved into the fully-fired position (FIG. 36)—similar to the interactionbetween the crimping drive 180 and the first and second jaws 123 a and123 b described above. In the home position (FIG. 37), the first andsecond crimping drive pins 70180 a and 70180 b engage the first jaw cam70124 a and the second jaw cam 70124 b, respectively, such that thefirst jaw 70123 a and the second jaw 70123 b are moved toward the openposition to release a crimped clip 70140 from the first and second jaws70123 a and 70123 b. When the crimping drive 70180 is in the homeposition, another clip 70140 can be advanced onto the protrusions 70126a and 70126 b as discussed above. Further, as the crimping drive 70180is moved from the home position (FIG. 37) to the fully retractedposition (FIG. 38) the first crimping drive pin 70180 a and the secondcrimping drive pin 70180 b transition the first jaw 70123 a and thesecond jaw 70123 b towards the open position, and thus, the clip 70140positioned around the protrusions 70126 a and 70126 b is expanded intothe expanded configuration, as discussed above. Alternative embodimentsare envisioned in which a crimped clip 70140 is released from the firstand second jaws 70123 a and 70123 b and, at the same time, another clip70140 positioned on the protrusions 70126 a and 70126 b is leastpartially expanded when the crimping drive is moved from the closedposition to the home position.

FIGS. 39 and 40 depict a clip applier 70150 in accordance with at leastone embodiment. The clip applier 70150 comprises a frame 70155, a firingmember 70160, a first jaw 70170 a, and a second jaw 70170 b. The firstjaw 70170 a and the second jaw 70170 b are pivotally coupled to theframe 70155 such that the first jaw 70170 a and the second jaw 70170 bare movable relative to each other. The clip applier 70150 is configuredto receive various types of clip cartridges, such as clip cartridge70130 depicted in FIG. 39, for example. The clip cartridge 70130comprises a cartridge body 70132 including a first cartridge jaw 70132 aand a second cartridge jaw 70132 b that oppose each other. When the clipcartridge 70130 is attached to the frame 70155 of the clip applier70150, the first cartridge jaw 70132 a biases the first jaw 70170 atowards the second jaw 70170 b, and the second cartridge jaw 70132 bbiases the second jaw 70170 b towards the first jaw 70170 a. Thus, whenthe clip cartridge 70130 is attached to the clip applier 70150, thefirst and second jaws 70170 a and 70170 b are approximated to form areceiving chamber 70175. The clip cartridge 70130 further comprises aplurality of clips 70136 removably stored in a clip housing 70134. Theclip cartridge 70130 further includes biasing members, such as springs70138 for example, configured to bias the clips 70136 out of the cliphousing 70134 into the receiving chamber 70175. Once in the receivingchamber 70175, a clip 70136 can be advanced by the firing member 70160into a crimping chamber in the distal end of the first and second jaws70170 a and 70170 b. A clip 70136 positioned in the crimping chamber canthen be crimped when the first jaw 70170 a and the second jaw 70170 bare moved towards each other.

FIG. 40 depicts a different clip cartridge 70130′ positioned in the clipapplier 70150. The clip cartridge 70130′ is similar to clip cartridge70130 discussed above, except for the differences discussed below. Theclip cartridge 70130′ is configured to store clips 70136′ which aresmaller than clips 70136. Other embodiments are envisioned where theclip cartridge 70130′ is configured to store clips that are larger thanclips 70136. In any event, clip cartridge 70136′ comprises, one, a cliphousing 70134′ which stores the clips 70136′ and, two, biasing members,such as springs 70138′ for example, which bias the stored clips 70136′into a receiving chamber 70175′. Further, the clip cartridge 70130′comprises a cartridge body 70132′, a first cartridge jaw 70132 a′, and asecond cartridge jaw 70132 b′ opposing the first cartridge jaw 70132 a′.The first cartridge jaw 70132 a′ and the second cartridge jaw 70132 b′extend further inward toward each other as compared to the firstcartridge jaw 70132 a and the second cartridge jaw 70132 b of the clipcartridge 70130. Stated another way, the gap between the first cartridgejaw 70132 a′ and the second cartridge jaw 70132 b′ is smaller than thegap between the first cartridge jaw 70132 a and the second cartridge jaw70132 b. When the clip cartridge 70130′ is attached to the clip applier70150, the receiving chamber 70175′ defined between the first jaw 70170a and the second jaw 70170 b will be smaller than the receiving chamber70175. By changing the distance between the first cartridge jaw and thesecond cartridge jaw of the clip cartridges 70130 and 70130′, varioussizes of receiving chambers can be created. The clip cartridges 70130and 70130′ can therefore be modified to approximate the first jaw 70170a and the second jaw 70170 b of the clip applier 70150 to receive anysuitable clip size.

FIG. 41 depicts a clip applier 70200 in accordance with at least oneembodiment. The clip applier comprises a shaft 70210 extending from ahousing, an end effector 70220 extending from the shaft 70210, a feedermember 70230 configured to move through the clip applier 70200 inresponse to rotary motions generated in the housing, and a clip magazine70240. The end effector comprises a pair of jaws 70225 configured tomove relative to each other between open and closed positions. The clipmagazine 70240 is not removable from the clip applier 70200; however,other embodiments are envisioned where the clip magazine 70240 isremovable and/or replaceable. The clip magazine 70240 comprises a firstlayer 70246 of clips 70244 and a second layer 70248 of clips 70244stored within the clip magazine 70240. The first layer 70246 of clips70244 are in a feeding position from which they can be ejected from theclip magazine 70240. The second layer 70248 of clips 70244 are storedabove the first layer 70246 of clips 70244 in a storage position fromwhich they cannot be ejected from the clip magazine 70240. Each of thefirst layer 70246 and second layer 70248 comprises three clips 70244,however, other embodiments are envisioned with more or less than threeclips. The first and second layers 70246 and 70248 are separated by adivider member, such as a divider plate 70249. The clip magazine 70240further comprises a top plate 70243 and biasing members 70242. The topplate 70243 rests on top of the second layer 70248 of clips 70244. Thebiasing members 70242 bias the top plate 70243 toward the top of thesecond layer 70248 of clips 70244 and, thus, bias the second layer 70248of clips 70244 toward the divider plate 70249. The divider plate 70249rests on top of the first layer 70246 of clips 70244 and a distalprotrusion 70232 of the feeder member 70230. The distal protrusion 70232extends above the feeder member 70230. Operation of the clip applier70200 is discussed in further detail below.

In use, the feeder member 70230 is translated distally to push the firstlayer 70246 of clips 70244 toward the end effector 70220 and out of theclip magazine 70240. As the first layer 70246 of clips 70244 is beingadvanced from the clip magazine 70240, the divider plate 70249 issupported by the distal protrusion 70232 of the feeder member 70230 andany of the clips 70244 which haven't been fully ejected from the clipmagazine 70240. Once the feeder member 70230 has advance all of theclips 70244 in the first layer 70246 out of the clip magazine 70240, thedivider plate 70249 is biased by the biasing members 70242 into a recess70233 in the feeder member 70230. The recess 70233 is defined betweenthe distal protrusion 70232 of the feeder member 70230 and a proximalprotrusion 70234 of the feeder member 70230 extending upward from theproximal end of the feeder member 70230. Once the divider plate 70249 isseated in the recess 70233, the feeder member 70230 and divider plate70249 can be retracted together proximally out of the clip magazine70240. After the feeder member 70230 and divider plate 70249 arecompletely retracted out of the clip magazine 70240, the second layer70248 of clips 70244 is biased by the biasing members 70242 into thefeeding position (i.e., where the first layer 70246 of clips 70244 usedto be). The feeder member 70230 and divider plate 70249 can be advancedtogether toward the end effector to eject the second layer 70248 ofclips 70244 from the clip magazine 70240. The reader will appreciatethat all of the clips 70244 in the first layer 70246 and/or second layer70248 are not ejected at the same time, rather, they are ejected one ata time to allow each clip 70244 to be sequentially crimped by the pairof jaws 70255 of the end effector 70220. The above being said, otherembodiments are envisioned in which more than one clip 70244 can beejected at a time.

FIG. 42A depicts a clip applier 70250 in accordance with at least oneembodiment. The clip applier 70250 comprises an elongate shaft 70260extending from a housing, a clip cartridge 70270 extending from theelongate shaft 70260, and an end effector 70280 extending from the clipcartridge 70270. The elongate shaft 70260 and the clip cartridge 70270define a shaft axis SA. The elongate shaft 70260 comprises a firstinwardly extending detent 70264 a and a second inwardly extending detent70264 b opposing the first inwardly extending detent 70264 a. The firstand second inwardly extending detents 70264 a and 70264 b extendinwardly toward the shaft axis SA and can flex outwardly away from theshaft axis SA when a force is applied thereto. The elongate shaft 70260further comprises a top notch 70262 a and a bottom notch 70262 bopposing the top notch 70262 a. The top notch 70262 a and the bottomnotch 70262 b are located in the distal end of the elongate shaft 70260.The clip cartridge 70270 is releasably attachable to the distal end ofthe elongate shaft 70260 as discussed in further detail below.

The clip cartridge 70270 comprises a top protrusion 70272 a and a bottomprotrusion 70272 b opposite the top protrusion 70272 a. The topprotrusion 70272 a and the bottom protrusion 70272 b extend from theclip cartridge 70270 away from the shaft axis SA. The clip cartridge70270 further comprises a first slot and a second slot 70274 b in theproximal end of the clip cartridge 70270. The first slot and the secondslot 70274 b oppose one another. The clip cartridge 70270 is configuredto slide into the inner diameter of the elongate shaft 70260 such thatthe top protrusion 70272 a slides into the top notch 70262 a, the bottomprotrusion 70272 b slides into the bottom notch 70262 b, the firstinwardly extending detent 70264 a engages the first slot of the clipcartridge 70270, and the second inwardly extending detent 70264 bengages the second slot 70274 b of the clip cartridge 70270 to attachthe clip cartridge 70220 to the elongate shaft 70260. After the clipcartridge 70270 is attached to the elongate shaft 70260, the elongateshaft 70260 and clip cartridge 70270 are fixedly coupled such that theycan rotate together about the shaft axis SA. Further, the clip cartridge70270 can be detached from the elongate shaft 70260 by a clinician whenthe clinician applies a distal force to the clip cartridge 70270 todisengage the first and second inwardly extending detents 70264 a and70264 b of the elongate shaft 70260 from the first slot and the secondslot 70274 b of the clip cartridge 70270.

Referring primarily to FIGS. 42A and 42B, the end effector 70280comprises a first jaw 70280 a and a second jaw 70280 b configured tomove relative to each other between an open position (FIG. 42A) and aclosed position (FIG. 42B). To this end, the first jaw 70280 a and thesecond jaw 70280 b comprise openings at the proximal end thereof whichare configured to receive a pin 70290. The pin 70290 is rotatablycaptured within an opening 70276 in the clip cartridge 70270. The pin70290 defines a pin axis PA which is orthogonal to the shaft axis SA.The first jaw 70280 a and the second jaw 70280 b are rotatable relativeto each other about the pin axis PA. When the first jaw 70280 a and thesecond jaw 70280 b are in the open position (FIG. 42A) a clip can bepositioned between the first jaw 70280 a and the second jaw 70280 b. Asthe first jaw 70280 a and the second jaw 70280 b are moved towards theclosed position (FIG. 42B) the clip is crimped between the first jaw70280 a and the second jaw 70280 b. The first jaw 70280 a and the secondjaw 70280 b are moved from the open position to the closed position by aclosure tube which cammingly engages the outer surfaces of the first jaw70280 a and the second jaw 70280 b as the closure tube moves distally.When the closure tube is retracted, the first jaw 70280 a and the secondjaw 70280 b are returned to the open position by a biasing member, orspring, which biases the first jaw 70280 a and the second jaw 70280 binto the open position. Other embodiments are envisioned where the firstjaw 70280 a and the second jaw 70280 b are movable from the closedposition to the open position by jaw cams on the first jaw 70280 a andthe second jaw 70280 b interacting with the closure tube, similar to jawcams 70124 a and 70124 b depicted in FIGS. 36-38, for example.

FIG. 43A depicts a clip applier 70300 in accordance with at least oneembodiment. The clip applier 70300 comprises a shaft 70310, an endeffector 70320 extending from the shaft 70310, a firing drive, and aclip magazine 70306. The clip magazine 70306 is built into the shaft70310 of the clip applier 70300 as depicted in FIG. 43A. However, otherembodiments are envisioned where the clip magazine 70306 is releasablyattachable to the clip applier 70300. The shaft 70310 comprises openings70308 on either side of the shaft 70310 which allow a user of the clipapplier 70300 to access the clip magazine 70306. Other embodiments areenvisioned with only one opening in the shaft 70310 of the clip applier.The clip applier 70300 further comprises an outer tube 70302 that isslidable along the shaft 70310 of the clip applier 70300. The outer tube70302 is configured to slide along the shaft 70310 to cover the openings70308 in the shaft 70310. The clip magazine 70306 is configured to storea plurality of clips, such as clips 70304 therein. The clips 70304 areinsertable into the clip magazine 70306 through the openings 70308 whenthe outer tube 70302 is not obstructing the openings 70308, as depictedin FIG. 43A. Once positioned in the clip magazine 70306, the clips 70304can be advanced out of the clip magazine 70306 into the end effector70320 by the firing member. In at least one embodiment, the clips 70304can be sequentially advanced out of the clip magazine 70306 into the endeffector 70320. When the outer tube 70302 is covering the openings70308, access to the clip magazine 70306 is prevented, and, if clips70304 have already been inserted into the clip magazine 70306, the outertube 70302 prevents the clips 70304 from exiting the clip magazine 70306through the openings 70308. Once all of the clips 70304 inside the clipmagazine 70306 have been advanced into the end effector 70320, the outertube 70302 can be retracted to allow a new set of clips to be insertedinto the clip magazine 70306. Further to the above, the outer tube 70302can be operably engaged with the firing member of the clip applier70300, such that, when the outer tube 70302 is retracted as depicted inFIG. 43A, or at least partially retracted, the firing member cannot beactuated.

FIG. 44 depicts a clip applier 70300′. Clip applier 70300′ is similar toclip applier 70300 in many respects. The clip applier 70300′ comprisesan elongate shaft 70315 extending from a housing, an articulation joint70314 extending from the elongate shaft 70315, a shaft assembly 70310′extending from the articulation joint 70314, an end effector 70320extending from the shaft assembly 70310′, and an outer tube 70302′positioned around the shaft assembly 70310′. The articulation joint70314 connects the elongate shaft 70315 to the shaft assembly 70310′ sothat the shaft assembly 70310′ can be articulated relative to theelongate shaft 70315. The shaft assembly 70310′ comprises a proximalshaft portion 70311 extending from the articulation joint 70314, adistal shaft portion 70312 extending from the proximal shaft portion70311, and a hinge 70307. The distal shaft portion 70312 furthercomprises a clip magazine 70306′. Other embodiments are envisioned wherethe proximal shaft portion 70311 comprises the clip magazine 70306′. Thehinge 70307 allows the distal shaft portion 70312 to rotate away fromthe proximal shaft portion 70311. The outer tube 70302′ is configured toslide along the shaft assembly 70310′ between a locked position and anunlocked position when the proximal shaft portion 70311 and distal shaftportion 70312 are aligned. More specifically, when the proximal shaftportion 70311 and distal shaft portion 70312 are aligned and the outertube 70302′ is in the locked position, the distal shaft portion 70312 isprevented from rotating away from the proximal shaft portion 70311 aboutthe hinge 70307. When the outer tube 70302′ is in the unlocked position,the distal shaft portion 70312 is capable of rotating away from theproximal shaft portion 70311 about the hinge 70307. Further to theabove, when the distal shaft portion 70312 is rotated away from theproximal shaft portion 70311, an opening 70308′ in the clip magazine70306′ is exposed. The opening 70308′ allows clips 70304′ to be insertedinto the clip magazine 70306′.

Further to the above, a clip reloader 70350 can be utilized to insertthe clips 70304′ into the clip applier 70300′ as depicted in FIG. 44.The clip reloader comprises a housing 70352, a trigger 70354 movablerelative to the housing 70352, a feeder bar operably engaged with thetrigger 70354, an elongate shaft 70356 extending from the housing 70352,and a docking station 70360 extending from the elongate shaft 70356. Aplurality of clips 70304′ are removably stored in the elongate shaft70356. In one embodiment, the elongate shaft 70356 stores 20 clipswithin a six inch span of the elongate shaft 70356. Other embodimentsare envisioned with different numbers of clips and spans, for example.The clips 70304′ are advanced from the elongate shaft 70356 into thedocking station 70360 by the feeder bar when the trigger 70354 is movedtowards the housing 70352. The docking station 70360 comprises a cavity70358 configured to dock with the shaft assembly 70310′ of the clipapplier 70300′ when the distal shaft portion 70312 is rotated away fromthe proximal shaft portion 70311. When the docking station 70360 isdocked with the shaft assembly 70310′ of the clip applier 70300′, theclips 70304′ can be advanced form the elongate shaft 70356 into the clipmagazine 70306′ of the clip applier.

FIGS. 45-47 depict a different clip reloader 70400. The clip reloader70400 is similar to the clip reloader 70350 in many respects. The clipreloader 70400 comprises a housing 70410, a plurality of clips 70404stored inside the housing 70410, and a plunger 70402. The plunger 70402extends into and is movable relative to the housing 70410. The clips70404 are stacked vertically in the embodiment illustrated in FIGS. 45and 46; however, other embodiments are envisioned where the clips arestacked horizontally. A feeder block 70406 extends from the plunger70402 and is slidably engaged with the inside of the housing 70410. Thefeeder block 70406 comprises angled portions that support the backsideof the top-most clip in the clip stack as depicted in FIG. 45. Thehousing 70410 comprises a boss 70408 extending from the bottom of thehousing 70410, and a flexible ramp 70409 extending from the bottom ofthe boss 70408. The housing 70410 further comprises a cutout region70411. Docking the clip reloader 70400 with a clip applier is discussedin further detail below.

In various circumstances, the clip reloader 70400 is configured toinsert the clips 70404 into a clip applier, such as clip applier 70450,for example. The clip applier 70450 comprises a shaft 70460, an endeffector 70480 extending distally from the shaft 70460, and anarticulation joint 70470 extending proximally from the shaft 70460. Toalign the clip reloader 70400 with the clip applier 70450, the boss70408 docks with an opening 70464 in the shaft 70460 of the clip applier70450, the cutout region 70411 mates with the exterior of the shaft70460, and the flexible ramp 70409 extends into a clip slot 70462 of theclip applier 70450 as depicted in FIG. 47. The opening 70464 leads tothe clip slot 70462 which comprises an angled portion that receives theboss 70408 and flexible ramp 70409 of the clip reloader 70400. The clipslot 70462 further comprises a flat portion that facilitates theadvancement of the clips 70404 into the end effector 70480 of the clipapplier 70450. The operation of the clip reloader 70400 in conjunctionwith the clip applier 70450 is discussed in further detail below.

In use, after the clip reloader 70400 is docked with the clip applier70450, the plunger 70402 is moved towards the clip applier 70450 toadvance the clips 70404 from the housing 70410 into the angled portionof the clip slot 70462. The ramp 70409 supports and guides the clips70404 from the angled portion of the clip slot 70462 into the flatportion of the clip slot 70462. As illustrated in FIG. 47, the housing70410 of the clip reloader 70400 is positioned at an angle relative tothe longitudinal axis of the clip applier 70450 when the clip reloader70400 is docked with the clip applier 70450. Other embodiments areenvisioned where the housing 70410 is orthogonal, or at leastsubstantially orthogonal, to the clip applier 70450 when docked.Referring primarily to FIG. 47, the clip applier 70450 further comprisesa flexible firing member 70465 positioned within a firing slot 70466located proximal to the clip slot 70462. After the clip reloader 70400is un-docked with the clip applier 70450, the flexible firing member70465 can move from the firing slot 70466 into the clip slot 70462 toadvance the clips 70404 into the end effector 70480. Once at least one,or all, of the clips 70404 have been advanced into the end effector70480, the flexible firing member 70465 can be retracted from the clipslot 70462 into the firing slot 70466 and additional clips 70404 can beloaded into the clip slot 70462 by the clip reloader 70400.

FIGS. 48-50 depict a clip applier 70500. The clip applier 70500comprises an elongate shaft 70570 (see FIG. 50) extending from ahousing, a shaft 70510 attachable to the elongate shaft 70570, an endeffector 70520 extending from the shaft 70510, and a clip magazine70530. The attachable shaft 70510 comprises an upper pivot link 70512and a lower pivot link 70514 extending distally therefrom. The endeffector 70520 comprises a first jaw 70521 a and a second jaw 70521 bmovable relative to each other between an open position and a closedposition about a pivot pin 70511. The pivot pin 70511 is constrainedwithin openings in the upper pivot link 70512 and the lower pivot link70514 of the shaft 70510. The clip magazine 70530 is removablypositioned within the attachable shaft 70510 and comprises a pluralityof clips 70532. The clip applier 70500 further comprises a closuresystem 70540 and a firing system 70550. The closure system 70540 and thefiring system 70550 are discussed in greater detail below.

The closure system 70540 comprises a proximal closure driver 70542comprising a threaded portion 70543, a distal closure driver 70566comprising a closure nut 70544, an upper closure hinge 70545 a, and alower closure hinge 70545 b. The proximal closure drive 70542 isconfigured to rotate in response to rotary motions generated inside thehousing of the clip applier. The closure drive 70542 transmitsrotational motion to the threaded portion 70543 which is threadablyreceived in the closure nut 70544. The closure drive 70542 can comprisea flexible portion to facilitate the transfer of rotational motion tothe closure nut 70544. The closure nut 70544 is rotatably constrainedwithin the shaft 70510 such that rotation of the threaded portion 70543in a first direction will result in translation of the nut 70544distally, and rotation of the threaded portion 70543 in a seconddirection—opposite the first direction—will result in translation of thenut 70544 proximally. The distal closure driver 70566 extends from theclosure nut 70544 and attaches to the upper closure hinge 70545 a andthe lower closure hinge 70545 b via a closure pin 70547. The closure pin70547 allows the upper and lower closure hinges 70545 a and 70545 b totranslate distally and proximally with the distal closure driver 70566while still being rotatable about the closure pin 70547. Further to theabove, the upper closure hinge 70545 a is rotatably engaged with aproximal portion 70523 a of the first jaw 70521 a, and the lower closurehinge 70545 b is rotatably engaged with a proximal portion 70523 b ofthe second jaw 70521 b. As illustrated in FIG. 48, the first jaw 70521 aand the second jaw 70521 b cross over each other about the pivot pin70511 in a scissor like formation. Such an arrangement allows the firstjaw 70521 a and the second jaw 70521 b to move toward the open positionwhen the upper and lower closure hinges 70545 a and 70545 b aretranslated distally by the closure system 70540, and allows the firstjaw 70521 a and the second jaw 70521 b to move toward the closedposition when the upper and lower closure hinges 70545 a and 70545 b aretranslated proximally by the closure system 70540.

The clip applier 70500 further comprises a firing system 70550comprising a firing member 70560. The firing member 70560 istranslatable through the end effector between an unfired position and afired position in response to the rotary motions that drive the closuresystem 70540. Other embodiments are envisioned where the closure system70540 and the firing system 70550 are operated by two separate motorswithin the housing of the clip applier, for instance. The firing member70560 is configured to advance a clip 70532 from the clip magazine 70530into the first and second jaws 70521 a and 70521 b of the clip applier70500. As illustrated in FIG. 49, the clip magazine 70530 is at leastpartially supported by the closure system 70540. More specifically, abiasing member, such as leaf spring 70546, for example, biases the clips70532 toward the firing member 70560 and holds the clip magazine 70530in position. Other embodiments are envisioned where the closure system70540 can align, and/or guide, and/or lock the clip magazine 70530 intoplace within the shaft 70510. The embodiment depicted in FIGS. 48 and 49illustrates the closure system 70540 arranged around the clip magazine70530 to allow a larger space inside the shaft 70510 for the clipmagazine 70530 and clips 70532; however, a closure system can have anysuitable arrangement. The closure system 70540 is discussed in furtherdetail below.

The threaded portion 70543 and closure nut 70544 of the closure system70540 allows for a more precise actuation of the first and second jaws70521 a and 70521 b when moving between the open position and the closedposition as compared to previous clip applier arrangements that utilizea translating closure tube or cam member. Rotary encoders and/or othersensors can be used in combination with the closure system 70540 toprovide even greater accuracy in determining the position of the firstand second jaws 70521 a and 70521 b.

Turning now to FIG. 50, the clip applier 70500 further compriseprotrusions 70513 and 70516 extending from the proximal end of the shaft70510. The protrusions 70513 and 70516 may be the same shape ordifferent shapes. The protrusions 70513 and 70516 are configured tolockingly engage slots 70572 a and 70572 b in the elongate shaft 70570of the clip applier 70500 to form a bayonet connection therebetween. Theslots 70572 a and 70572 b comprise L-shaped portions that lock theprotrusions 70513 and 70516 into place when the shaft 70510 is insertedinto and then rotated relative to the elongate shaft 70570. FIG. 50further depicts a clip 70532 located within the first jaw 70521 a andthe second jaw 70521 b. The clip 70532 and other embodiments of clipsfor use with a clip applier, such as clip applier 70500, are discussedin further detail below.

Turning now to FIGS. 51A and 51B, the clip 70532 comprises a baseportion 70534, a first leg 70534 a extending from the base portion70534, and a second leg 70534 b extending from the base portion 70534and opposing the first leg 70534 a. The base portion 70534 can comprisea flexible material, such as plastic and/or any other suitable flexiblematerial, to allow the clip 70532 to flex between multiple positionswithout breaking or becoming plastically deformed in an unsuitablemanner. For example, the clip 70532 can be moved between a magazinestorage configuration, a pre-firing configuration, and a post-firingconfiguration as depicted in FIG. 51B. The first leg 70534 a comprises areinforced region comprising a ridge 70535 a, and the second leg 70534 bcomprises a reinforced region comprising a ridge 70535 b. The ridges70535 a and 70535 b extend along at least a portion of the first leg70534 a and the second leg 70534 b, respectively. The ridges 70535 a and70535 b act as a rigid backbone to prevent, or at least substantiallyreduce, the deformation of the first leg 70534 a and the second leg70534 b during crimping. Other embodiments are envisioned where only oneof the first leg 70534 a and the second leg 70534 b comprises a ridge.The ridges 70535 a and/or 70535 b may be comprised of a rigid material,such as a fiberglass-filled and/or particle-filled plastic, for example,to prevent, or at least reduce, deflection of the first leg 70534 aand/or the second leg 70534 b when the clip 70532 is crimped. The clip70532 further comprises a locking portion, such as tooth 70536, forexample, extending from a portion of the first leg 70534 a. The tooth70536 lockingly engages the edges of an opening, or window, 70537 in thesecond leg 70534 b when the clip 70532 is crimped (see the post-firingconfiguration in FIG. 51B). Such an arrangement allows the clip 70532 tostay in a crimped state after the clip 70532 has been released from thejaws of a clip applier. Further, the clip 70532 includes grip features,such as protrusions 70538, extending from the inside surfaces of thefirst and second legs 70534 a and 70534 b. The protrusions 70538 engagetissue clamped between the first and second legs 70534 a and 70534 bwhen the clip 70532 is crimped. The protrusions 70538 prevent, or atleast substantially reduce, the movement of the tissue relative to theclip 70532 after the clip 70532 is crimped around the tissue. Theprotrusions 70538 may be any number of shapes and sizes, such aspyramidal shapes, conical shapes, frustoconical shapes, for example,and/or any other suitable shape.

Turning now to FIGS. 51C-51F, a different clip 70580 for use with a clipapplier is depicted. The clip 70580 is similar to clip 70532 in manyrespects. That said, the base 70534 of the clip 70580 comprises a stressrelief notch 70588 on the side of the base 70534 opposite the first andsecond legs 70534 a and 70534 b. In use, the stress relief notch 70588allows the first and second legs 70534 a and 70534 b to flex inwardlyand then outwardly a number of times without being plastically deformedin an unsuitable manner. However, in various circumstances, the clip70580 can be configured to yield, or deform plastically, when the clip70580 is sufficiently compressed. Such designed or controlled yielding,in various instances, can help the clip 70580 fold into the desiredshape.

FIGS. 52-60 depict a clip applier 70600. Turning now to FIG. 53, theclip applier 70600 comprises a shaft 70610 extending from a housing, anend effector 70605 extending from the shaft 70610, and a rotatable clipmagazine 70650. The end effector 70605 comprises a first jaw and asecond jaw that are movable relative to each other between an openposition and a closed position, similar to the first jaw 70123 a and thesecond jaw 70123 b of the clip applier 70100 discussed above. Therotatable clip magazine 70650 is rotatably and slidably supported withinthe clip applier 70600. More specifically, the rotatable clip magazine70650 is rotatable about shaft axis SA and translatable along shaft axisSA. The shaft axis SA is defined by the shaft 70610. Further detailregarding how the clip magazine 70650 is supported within the clipapplier 70600 is provided below.

Referring to FIG. 52, the rotatable clip magazine 70650 comprises a bodyportion 70652 including five sides, each of which comprises a clipchannel 70656 configured to removably store a clip 70654 therein. Thebody portion 70652 further comprises an opening 70653 that extendsthrough the body portion 70652. In the illustrated embodiment, the bodyportion 70652 is pentagonal in shape, for example; however, otherembodiments are envisioned in which the opening 70653 comprisesdifferent shapes to allow for more than or less than five clip channels70656 and, therefore, more than or less than five clips 70654 stored inthe rotatable clip magazine 70650. In at least one embodiment, the clips70654 comprise a clip width of 0.080″, a clip thickness of 0.03″, and aclip length of 0.310″ (for a LIGAMAX 5 Clip) or 0.315″ (for an ER320Clip), for example; however, clips having any suitable size can be used.Moreover, it is envisioned that the clips stored in the clip magazine70650 will have the same, or at least substantially the same size;however, alternative embodiments are envisioned in which clips havingdifferent sizes may be stored in the same clip magazine. Further, in atleast one embodiment, the overall diameter of the entire rotatable clipmagazine 70650 is 0.996″, for example; however, the clip magazine 70650can have any suitable diameter—including diameters which can permit theclip magazine 70650 to be inserted through a trocar. The rotatable clipmagazine 70650 further includes a clocking portion, such as teeth 70658,for example, extending proximally from the clip magazine 70650. The clipapplier 70600 comprises several drives and drivers which define themotion and/or operating sequence of the clip applier 70600, as describedin further detail below.

Referring again to FIG. 53, the clip applier 70600 further comprises aclosure tube 70620, a feeder member 70630, and a firing member 70640.The closure tube 70620 comprises a closure drive 70625 extendingproximally from the closure tube 70620. The closure drive 70625 extendsthrough the opening 70653 in the clip magazine 70650 and is operablyengaged with an actuator inside the housing of the clip applier 70600.The clip magazine 70650 is supported on at least a portion of theclosure drive 70625. The closure tube 70620 is at least partiallysupported and aligned within a recess in the shaft 70610. The closuretube 70620 is movable between a plurality of positions, such as a fullyretracted position, a home position, and a fully advanced position (seeFIGS. 53 and 54A). Similar to the crimping drive 70180 of the clipapplier 70100, the closure tube 70620 is configured to move the firstjaw and the second jaw of the end effector 70605 toward and away fromeach other. When the closure tube 70620 moves distally, the closure tube70620 cammingly engages the first and second jaws to move the first andsecond jaws to the closed position and, when the closure tube 70620moves proximally, the closure tube 70620 engages jaw cams on each of thefirst and second jaws to move the first and second jaws to the openposition. That said, any suitable jaw opening and closing arrangementcould be used.

The feeder member 70630 is aligned with one of the clip channels 70656of the rotatable clip cartridge 70650, and is configured to advance aclip 70654 out of the clip channel 70656 that is aligned with the feedermember 70630 toward the end effector 70605. The feeder member 70630 istranslatable linearly through the clip applier 70600 by a feeder gear70638 and a feeder drive 70635 which are operably engaged with a rackportion of the feeder member 70630. The feeder drive 70635 comprises apinion gear 70637 at the distal end thereof which is operably engagedwith the feeder gear 70638 such that, as the feeder drive 70635 isrotated, the feeder member 70630 is translated linearly through the clipapplier 70600. The feeder drive 70635 is operably engaged with a firstmotor inside the housing of the clip applier 70600. The first motortransmits rotational motion to the feeder drive 70635. Similar to theoperation of the feeder member 70630, the firing member 70640 istranslatable linearly through the clip applier by a firing gear 70648and a firing drive 70645 which are operably engaged with a rack portionof the firing member 70640. The firing drive 70645 comprises a piniongear 70647 on the distal end thereof which is engaged with the firinggear 70648 such that, as the firing drive 70645 is rotated, the firingmember 70640 is translated linearly through the clip applier 70600.Further, the firing drive 70645 is operably engaged with a second motorinside the housing of the clip applier 70600. The second motor transmitsrotational motion to the firing drive 70645. Other embodiments areenvisioned where the feeder drive 70635 and the firing drive 70645 arerotatable by the same motor utilizing a transmission. Further, otherembodiments are envisioned, and are described further below, where thefeeder member 70630 and the firing member 70640 translate togetherthrough the clip applier 70600. Operation of the feeder member 70630 andfiring member 70640 are also described in greater detail below.

Referring primarily to FIG. 53, the firing member 70640 comprises adistal portion 70640 a extending therefrom that is configured to advancea clip 70654 into the end effector. The shaft 70610 further includes aground portion 70612 mounted to the shaft 70610 and aligned with theclip magazine 70650. The ground portion 70612 is mounted to the shaft70610 such that the ground portion 70612 is not movable, translatable,and/or rotatable relative to the shaft 70610. The ground portion 70612includes a clocking portion, such as teeth 70614, for example, extendingdistally therefrom as illustrated in FIG. 54B. The teeth 70614 of theground portion 70612 are aligned, or at least substantially aligned,with the teeth 70658 of the rotatable clip magazine 70650. Further, theground portion 70612 supports a biasing member, such as spring 70616,for example, thereon. The spring 70616 biases the clip magazine 70650distally toward the closure tube 70620 and the end effector 70605, asillustrated in FIG. 54A. Other embodiments are envisioned where thespring comprises a leaf spring and the clip applier 70600 furthercomprises a track and the leaf spring can be configured to both indexthe clip magazine 70650 and prevent the clip magazine 70650 from counterrotation. In any event, the rotation of the clip magazine 70650 aboutthe shaft axis SA and translation of the clip magazine 70650 along shaftaxis SA is described in further detail below.

Referring primarily to FIG. 52, the closure tube 70620 includes clockingchannels 70622 located radially around the closure drive 70625. Theclosure drive 70625 rotatably and slidably supports the rotatable clipmagazine 70650 thereon as discussed above. The clocking channels 70622are engaged with protrusions within the opening 70653 of the clipmagazine 70650 to rotatingly lock the clip magazine 70650 into placerelative to the closure tube 70620 when the closure tube is in the homeposition or the fully advanced position. When the closure tube 70620 ismoved to the fully retracted position, as illustrated in FIG. 53, thespring 70616 moves/biases the clip magazine 70650 toward the closuretube 70620 resulting in the clocking channels 70622 becoming disengagedfrom the protrusions within the opening 70653 of the clip magazine70650. As such, the clip magazine 70650 can rotate freely about shaftaxis SA. Further, when the closure tube 70620 is moved to the fullyretracted position, the teeth 70658 of the clip magazine 70650 engagethe teeth 70614 of the ground portion 70612 to rotate (i.e., cycle) theclip magazine 70650. More specifically, the teeth 70658 and the teeth70614 are structured to rotate the clip magazine 70650 about the shaftaxis SA a predefined amount of degrees based on the spacing and anglesof the teeth 70658 relative to the teeth 70614. The reader willappreciate that the spacing and angles of the teeth 70658 relative tothe teeth 70614 can be designed to generate a suitable degree ofrotation for the clip magazine 70650 about shaft axis SA. In theembodiment depicted in FIGS. 52-54A, the teeth 70658 and the teeth 70614are spaced and aligned such that, when they are engaged, the clipmagazine 70650 rotates 72 degrees to align an adjacent clip 70654 withthe feeder member 70630. After the clip magazine 70650 is cycled, theclosure tube 70620 can be moved distally from the fully retractedposition to the home position (FIG. 54A) resulting in the clockingchannels 70622 engaging the protrusions in the opening 70653 of the clipmagazine 70650 to lock the rotation of the clip magazine 70650 asdiscussed above. Usage of the clip applier 70600 to advance, form, andfire a clip 70654 is describe in further detail below.

As mentioned above, the feeder member 70630 and firing member 70640 canbe translatable together. For simplicity, FIGS. 55-60 illustrate thefunctions of clip applier 70600 where the feeder member 70630 and firingmember 70640 move together to feed and fire a clip 70654 from therotatable clip magazine 70650. Turning now to FIGS. 55 and 56, a clip70654 is advanced from the rotatable clip magazine 70650 into engagementwith a biasing member, such as a leaf spring 70624, for example, of theclosure tube 70620 by the feeder member 70630. The leaf spring 70624biases and guides the clip 70654 onto the top of the firing member70640, as illustrated in FIG. 56. When the firing member 70640 andfeeder member 70630 are retracted, the clip 70654 is moved furtherdownward by the leaf spring 70624 and seated around pre-form features,such as protrusions 70608, for example, depicted in FIG. 57. Protrusions70608 can be similar to protrusions 70126 a and 70126 b described above(See FIGS. 35A and 35B). One protrusion 70608 is located on one jaw ofthe end effector 70605, and another protrusion 70608 is located onanother jaw of the end effector 70605.

When the closure tube 70620 is in the fully retracted position,referring to FIG. 58, the jaws of the clip applier 70600 are in the openposition and the protrusions 70608 expand the clip 70654 from a storageconfiguration into a firing configuration—similar to the expansion ofclip 70140 described above in connection with FIGS. 35A and 35B. Whenthe closure tube 70620 is moved to the fully retracted position, asdescribed above, the rotatable clip magazine 70650 is rotated (i.e.,cycled) about the shaft axis SA to position another clip 70654 intoalignment with the feeder member 70630. Turning to FIG. 59, the firingmember 70640 can be moved toward the end effector 70605 to advance theclip 70654 over the protrusions 70608 and into the end effector 70605.As discussed above in connection with protrusions 70126 a and 70126 b,the protrusions 70608 can comprise angled portions that allow the clip70654 to slide over the protrusions 70608 when advanced distally by thefiring member 70640. Once the clip 70654 is positioned in the endeffector 70605, the closure tube 70620 can be moved to the fullyadvanced position (FIG. 60) to move the jaws from the open position tothe closed position to crimp the clip 70654 positioned between the jaws.

Because the feeder member 70630 and the firing member 70640 translatetogether, further to the above, the feeder member 70630 advances anotherclip 70654 (i.e., the clip that was rotated into position when theclosure tube 70620 was fully retracted) from the clip cartridge 70650down onto the firing member 70654 with the aid of the leaf spring 70624,as discussed above, when the firing member 70640 advances a clip 70654into the end effector 70605. Again, the firing member 70640 and thefeeder member 70630 can be retracted to allow the new clip 70654 to bebiased downward by the leaf spring 70624 and seated around theprotrusions 70608. The new clip 70654 can then be expanded to the firingconfiguration as clip magazine 70650 is cycled, and then the new clip70654 can be advanced into the end effector 70605 for crimping asdiscussed above. The process discussed above can be repeated until theclip magazine 70650 has been spent. The reader will appreciate that theclosure tube 70620 can be moved between the home position (FIGS. 56 and57) and the fully advanced position (FIG. 60) to crimp and release aclip 70654 within the end effector 70605 without cycling the clipmagazine 70650. This allows the jaws of the end effector 70605 to movebetween the open and closed positions without cycling the clip magazine70650 and/or ejecting another clip from the clip magazine 70650.

FIG. 61 depicts a clip applier 70700 in accordance with at least oneembodiment. The clip applier 70700 comprises a shaft 70710 extendingfrom a housing, an end effector 70705 extending from the shaft 70710,and a clip cartridge 70720 that is releasably attachable to the clipapplier 70700. The end effector 70705 comprises a first jaw and a secondjaw movable relative to each other, similar to the first and second jaws70123 a and 70123 b discussed above. The clip applier 70700 furthercomprises a firing system 70730 that comprises a rotatable drive 70732which is operably responsive to a motor inside the housing of the clipapplier 70700. The rotatable drive 70732 comprises a threaded portion.The firing system 70730 further includes a firing member 70736 and afiring nut 70734. The firing nut 70734 is threadably received on thethreaded portion of the rotatable drive 70732. The firing nut 70734 isrotatably constrained within the clip applier 70700 such that therotation of the rotatable drive 70732 translates the firing nut 70734through the clip applier 70700. The firing member 70736 is engaged withthe firing nut 70734 and translates into the first and second jaws ofthe end effector 70705 in response to translation of the firing nut70734 by the rotatable drive 70732. Attachment of the clip cartridge70720 to the clip applier 70700 is described in greater detail below.

The clip applier 70700 further comprises a docking region, or recess70714, in the distal end of the clip applier 70700, as illustrated inFIG. 61. The clip cartridge 70720 comprises a body portion 70722 that isslidably receivable in the recess 70714 of the clip applier 70700. Alocking feature 70728 extends proximally from the clip cartridge 70720.The locking feature 70728 includes an angled surface 70728 a at theproximal end thereof and a detent 70728 b extending downwardly, althoughthe locking feature 70728 can include any suitable arrangement. Thelocking feature 70728 engages a protrusion 70712 of the shaft 70710 whenthe clip cartridge 70720 is docked within the recess 70714. Morespecifically, the angled surface 70728 a slides over the protrusion70712 and the downwardly extending detent 70728 b locks into placeproximal to the protrusion 70712, thus locking the clip cartridge 70720to the clip applier 70700. In such instances, the locking feature 70728deflects as the angled surface 70728 a slides over the protrusion 70712and then resiliently returns to, or at least toward, its undeflectedconfiguration, when the detent 70728 b locks into place. A sufficientdistal pulling motion can cause the locking feature 70728 to deflect andrelease the clip cartridge 70720 from the clip applier 70700. Operationof the clip applier 70700 is described in further detail below.

The clip cartridge 70720 further comprises a ramp portion 70721, aplurality of clips 70724 positioned in a stack, and biasing members,such as springs 70726, for example. The clips 70724 are biased towardthe ramp portion 70721 by the springs 70726. In fact, the top clip 70724in the stack of clips is biased into the ramp portion 70712 by thesprings 70726. When the clip cartridge 70720 is docked with the clipapplier 70700, as discussed above, the ramp portion 70721 aligns with afeeder drive 70740 of the clip applier 70700. The feeder drive 70740 isoperably responsive to an actuator within the housing of the clipapplier 70700. The feeder drive 70740 is configured to reciprocatinglyactuate into the ramp portion 70721. To accommodate an angled portionwithin the ramp portion 70721 the feeder drive 70740 can be flexible.The feeder drive 70740 feeds the top clip 70724 in the stack of clipsthrough the ramp portion 70721 and into the end effector 70720. Once inthe end effector 70705, the clip 70724 can be advanced further distallyinto the first and second jaws of the end effector 70705 by translationof the firing member 70736, as discussed above. Once located in thefirst and second jaws, the clip 70724 can be crimped by a crimpingdrive. The feeder drive 70740 can be retracted, allowing another clip70724 to be biased into the ramp portion 70721. The feeder drive 70740can advance the new clip 70724 through the ramp portion 70721 and intothe first and second jaws of the end effector 70705 as discussed above.The process discussed above can be repeated until all of the clips 70724in the clip cartridge 70720 have been depleted, and/or until a suitablenumber of clips have been applied to the tissue.

FIG. 62A depicts a clip applier system 70750 in accordance with at leastone embodiment. The clip applier system 70750 comprises a shaft 70760extending from a housing, the clip applier 70250 depicted in FIG. 42positioned at least partially within the shaft 70760, and the rotatableclip magazine 70650 depicted in FIGS. 52-60 positioned within the shaft70760. A feeder member is configured to advance the clips 70654 from therotatable clip magazine 70650—one at a time—into the first and secondjaws 70280 a and 70280 b of the clip applier 70250. Once located withinthe first and second jaws 70280 a and 70280 b, the clip 70654 can becrimped as discussed above in relation to FIGS. 42A and 42B. Once theclip 70654 is crimped, the rotatable clip magazine 70650 can be cycled(i.e., rotated) to position another clip 70654 for advancement into thefirst and second jaws 70280 a and 70280 b of the clip applier 70250 bythe feeder member. This process can continue until all of the clips70654 in the rotatable clip magazine 70650 have been spent. After all ofthe clips 70654 have been spent, the rotatable clip magazine 70650 canbe replaced with another rotatable clip magazine 70650 containing a fullcomplement of clips 70650. Other embodiments are envisioned where thespent rotatable clip magazine 70650 can be detached from the clipapplier system 70750, reloaded with clips 70650, and then re-attached tothe clip applier system 70750 for further use.

Turning now to FIGS. 63A and 63B, an articulation joint 70800 for usewith a clip applier is illustrated. The articulation joint 70800releasably couples a clip cartridge 70820 to a shaft 70810 of a clipapplier. The shaft 70810 comprises an articulation pivot, or pivot pin70814, extending from the inside of the shaft 70810. The pivot pin 70814comprises a base portion 70817, a first leg 70814 a extending from thebase portion 70817, and a second leg 70814 b extending from the baseportion 70817 and opposing the first leg 70814 a. The first and secondlegs 70814 a and 70814 b extend away from each other. The first leg70814 a comprises a first detent, or shoulder, 70816 a extendingoutwardly from the first leg 70814 a, and the second leg 70814 bcomprises a second detent, or shoulder, 70816 b extending outwardly fromthe second leg 70814 b. The clip cartridge 70820 comprises a firstopening 70822 and, also, a second opening 70824 positioned adjacent andlateral to the first opening 70822. The first opening 70822 is centeredin the clip cartridge 70820 and rotatably receives the pivot pin 70814when the clip cartridge 70820 is attached to the shaft 70810. The firstleg 70814 a and the second leg 70814 b flex towards each other when thefirst opening 70822 is slid onto the pivot pin 70814 due to angledsurfaces at the end of each of the first leg 70814 a and second leg70814 b (See FIG. 63B). As the first leg 70814 a and second leg 70814 bflex toward each other, the pivot pin 70814 can slide through the firstopening 70822 until the first and second detents 70816 a and 70816 bclear the first opening 70822, as illustrated in FIG. 63B. Once thefirst and second detents 70816 a and 70816 b clear the first opening70822, the first and second legs 70814 a and 70814 b can expand to lockthe clip cartridge 70820 to the pivot pin 70814. More specifically, thebottom surfaces of the first and second detents 70816 a and 70816 b reston an outer surface 70826 of the clip cartridge 70822 preventing theclip cartridge 70820 from being detached from the pivot pin 70814 unlessa sufficient force is applied that exceeds a predetermined, or designed,force threshold. The reader will appreciate that, with force, a user ofthe clip applier can attach and detach the clip cartridge 70820 to theshaft 70810. Articulation of the clip cartridge about the pivot pin70814 is described in further detail below.

The clip applier depicted in FIGS. 63A and 63B further comprises arotatable output 70830 that is operably responsive to a motor locatedwithin the housing of the clip applier. The rotatable output 70830 isthreadably engaged with a threaded portion 70834 of an articulation bar70832. Rotation of the rotatably output 70830 in a first directiontranslates the articulation bar 70832 distally, and rotation of therotatable output 70830 in a second, or opposite, direction translatesthe articulation bar 70832 proximally. The articulation bar 70832comprises a downwardly extending protrusion 70836 that is slidablyreceived in a slot 70812 defined in the shaft 70810. The protrusion70836 and slot 70812 guide the articulation bar 70832 as thearticulation bar 70832 translates and limit relative lateral motionbetween the articulation bar 70832 and the shaft 70810. The articulationbar 70832 further comprises an upwardly extending protrusion 70838 whichis received in the second opening 70824 of the clip cartridge 70820 whenthe clip cartridge 70820 is attached to the shaft 70810. In use, thedistal translation of the articulation bar 70832 will rotate the clipcartridge 70820 about the pivot pin 70814 in a first direction and theproximal translation of the articulation bar 70832 will rotate the clipcartridge 70820 about the pivot pin 70814 in a second, or opposite,direction. The articulation bar 70832 can be flexible to allow thearticulation bar 70832 to flex as needed when the clip cartridge 70820is articulated about the pivot pin 70814.

FIG. 64 depicts a clip applier 70900 in accordance with at least oneembodiment. The clip applier 70900 comprises an elongate shaft 70910, anarticulation joint 70920, and a distal head 70930. The articulationjoint 70920 extends from the elongate shaft 70910 and the distal head70930 extends from the articulation joint 70920. The distal head 70930comprises a distal shaft 70932 attached to the articulation joint 70920,an end effector 70936 including a first jaw 70936 a and a second jaw70936 b, and a clip cartridge 70934. The first jaw 70936 a and secondjaw 70936 b are movable relative to each other between open and closedpositions by any suitable drive system, such as the drive systemsdisclosed herein, for example. The clip cartridge 70934 stores aplurality of clips which can be advanced into the end effector 70936 andcrimped by the first jaw 70936 a and the second jaw 70936 b. The clipcartridge 70934 is removably attachable to the distal shaft 70932 via akeying arrangement 70938. Other embodiments are envisioned where theclip cartridge 70934 is not removably attachable to the distal shaft70932. The elongate shaft 70910 defines a first roll axis RA₁ and thedistal head 70930 defines a second roll axis RA₂. The elongate shaft70910 and the distal head 70930 are articulable relative to each otherabout articulation axis AA via the articulation joint 70920. Thearrangement depicted in FIG. 64 is attachable—via the elongate shaft70910—to a plurality of clip applier handle types, such as, a standardhandle (i.e., a wand grip) and/or a pistol grip handle, for example.Depending on the type of handle that is attached to the elongate shaft70910, different actuations of, or within, the handle may performdifferent actuations of the arrangement depicted in FIG. 64 about thefirst roll axis RA₁, the second roll axis RA₂, and the articulation axisAA. These actuations are described in further detail below.

If the elongate shaft 70910 is attached to a standard handle (i.e., awand handle), referring still to FIG. 64, the elongate shaft 70910, thearticulation joint 70920, and the distal head 70930 are all rotatableabout the first roll axis RA₁ by the clinician rotating the wand handle.Further, a rotary knob on the wand handle is operably engaged with theelongate shaft 70910, through an electric motor and/or control system,for example, such that manually rotating the rotary knob will result inthe distal head 70930 rotating about the second roll axis RA₂. Further,articulation of the distal head 70930 relative to the elongate shaft70910 about articulation axis AA is driven by an articulation driveroperably engaged with a motor housed within the wand handle, forexample. If the elongate shaft 70910 is attached to a pistol griphandle, such as the handle 700 discussed above, for example, theelongate shaft 70910, the articulation joint 70920, and the distal head70930 are all rotatable about the first roll axis RA₁ by a rotary knob,for example. Further, the distal head 70930 is rotated about the secondroll axis RA₂ by a dedicated motor within the pistol grip handle.Further still, articulation of the distal head 70930 relative to theelongate shaft 70910 about articulation axis AA is induced by anarticulation driver operably engaged with a motor housed within thepistol grip handle. The reader should appreciate that, depending on thetype of handle attached to the arrangement depicted in FIG. 64, rotationof the elongate shaft 70910 about the first roll axis RA₁ can beaccomplished by rotating the entire handle manually, rotation of arotary knob engaged with the elongated shaft, and/or by a dedicatedmotor inside the handle. Further, the rotation of the distal head 70930about the second roll axis RA₂ can be accomplished by rotation of arotary knob engaged within the elongate shaft 70910 or by a dedicatedmotor inside the handle.

A clip applier jaw assembly 70950, or half of the jaw assembly 70950,and a clip leg 70954 of a clip are illustrated in FIG. 65. As can beseen in FIG. 65, the clip applier jaw assembly 70950 comprises a firstjaw 70950 a which includes a base 70952, a first leg 70952 a extendingfrom the base 70952, and a second leg 70952 b extending from the base70952. The first leg 70952 a and second leg 70952 b oppose one anotherand define a receiving area 70953 therebetween. The clip leg 70954 isreceived in the receiving area 70953 but, notably, part of the clip leg70954 cross-section is not positioned within the receiving area 70953.Thus, only portions of the clip leg 70954 cross-section are supported bythe first jaw 70950 a. Other arrangements exist where the receiving area70953 is substantially the same depth and width as the clip leg 70954 ofthe clip such that all, or at least substantially all, of thecross-section of the clip leg 70954 is positioned within the receivingarea 70953 and supported by the first jaw 70950 a.

A clip applier jaw assembly 70960 is depicted in FIG. 66A. The clipapplier jaw assembly 70960 comprises a first jaw 70960 a which includesa base 70962, a first leg 70962 a, a second leg 70962 b, and a receivingarea 70963 which receives a first clip leg 70964 of a clip. The firstleg 70962 a of the first jaw 70960 a extends from the base portion 70962beyond the first clip leg 70964 when the first clip leg 70964 is seatedin the receiving area 70963. The second leg 70962 b of the first jaw70960 a extends from the base portion 70962 and terminates prior to theend of the first clip leg 70964 such that only a portion of the firstclip leg 70964 is supported by the second leg 70962 b of the first jaw70960 a.

The clip applier jaw assembly 70960 further comprises a second jaw 70960b positioned opposite, or opposing, the first jaw 70960 a. The secondjaw 70960 b comprises a base 70962′, a first leg 70962 a′, a second leg70962 b′, and a receiving area 70963′ which receives a second clip leg70964′ of the clip. The second jaw 70960 b opposes the first jaw 70960 asuch that the first leg 70962 a of the first jaw 70960 a is aligned withthe first leg 70962 a′ of the second jaw 70960 b, and the second leg70962 b of the first jaw 70960 a is aligned with the second leg 70962 b′of the second jaw 70960 b. The second leg 70962 b′ of the second jaw70960 b extends from the base portion 70962′ beyond the second clip leg70964′ of the clip when the second clip leg 70964′ is seated in thereceiving area 70963′. Further, the first leg 70962 a′ of the second jaw70960 b extends from the base portion 70962′ and terminates prior to theend of the second clip leg 70964′ such that only a portion of the secondclip leg 70964′ is supported by the first leg 70962 a′ of the second jaw70960 b.

When the first jaw 70962 a and the second jaw 70962 b of the clipapplier jaw assembly 70960 are in a closed configuration, as depicted inFIG. 66B, the first leg 70962 a of the first jaw 70960 a supports theentire first clip leg 70964 of the clip and, also, a portion of thesecond clip leg 70964′ of the clip. Further, the second leg 70962 b′ ofthe second jaw 70960 b supports the entire second clip leg 70964′ of theclip and, also, a portion of the first clip leg 70964 of the clip.Because the first leg 70962 a of the first jaw 70960 a and the secondleg 70962 b′ of the second jaw 70960 b are opposite one another, thecross-sections of the first clip leg 70964 and the second clip leg70964′ are supported by both the first jaw 70960 a and the second jaw70960 b—along at least a portion of the leg lengths. Such an arrangementprevents, or at least inhibits, the clip from twisting when the clip iscrimped.

Referring to FIG. 67, the clip leg 70954 is seated within the first clipjaw 70950 a of the clip applier jaw assembly 70950 but is not preventedfrom being slid longitudinally within the clip applier jaw assembly70950. In accordance with at least one embodiment, such as the clipapplier jaw assembly 70960, for example, the first jaw 70960 a and/orthe second jaw 70960 b comprise a clip ejection prevention feature, suchas distal stop 70966. The distal stop 70966 prevents the clip 70964 fromsliding out of the distal end of the first jaw 70950 a and/or the secondjaw 70950 b of the clip applier jaw assembly 70960. Other clip applierjaw shapes and guidance features configured to control the position ofthe clip, and/or prevent the unintentional dropping and/or ejection ofthe clip from the clip applier, are discussed in greater detail below.

As discussed above, the jaws of a clip applier, or “clip jaws”, are usedto deform the clips. As the reader should appreciate, the clip jawsthemselves undergo stresses and strains and, in some instances, can beplastically deformed. Clip jaws designed to resist plastic deformationduring use may comprise clip jaws which vary in thickness, width, and/orclip path depth along the clip jaw lengths in order to improve thestiffness in a lap clip applier, for example. Further, a proximalportion of one of the clip applier jaws can comprise a protruding bar(i.e., a tongue portion) and a proximal portion of the other clipapplier jaw can comprise a recess (i.e., a groove portion) such that theprotruding bar is seated in the recess when the clip applier jaws areclosed. Such an arrangement provides for superior jaw resilience tovertical skewing and/or twisting of the clip applier jaws relative toeach other during crimping of a clip. Improved clip retention structuresare discussed in further detail below.

In at least one embodiment, the clip applier jaws may comprise a clipretention channel, or recess, to allow a clip to be advanced into theclip applier jaws via a feeder member from below. The feeder memberincludes a flexible drive plate that is retracted when the clip applierjaws are actuated (i.e., moved from an open position to a closedposition) and is extended into the distal end of the clip applier jawsto hold the clip in a distal position until the clip applier jaws areactuated. Further, the feeding member prevents any further clips frominadvertently advancing into the clip applier jaws until the feedermember is retracted to retrieve and advance the next clip. Clip applierjaws including a distal retaining feature are discussed in greaterdetail below.

In at least one embodiment, the clip applier jaws each comprise a distalretaining feature, such as a ledge, for example, that extends above aguidance trough in the clip applier jaws. The guidance trough maycomprise retention features, such as recesses, for example, on thedistal end thereof which mate with protrusions on the clip to allow theclip to remain in a distal position within the clip applier jaws withoutneeding to be held into place by a firing member and/or feeder member.The construction and manufacturing of certain clip applier jaws isdiscussed in greater detail below.

In various embodiments, the clip applier jaws are manufactured using atwo part method where at least the distal portions of the clip applierjaws are metal injection molded (MIM) within an injection mold. Incertain instances, the injection mold comprises two sides which aretranslatable toward and away from each other along a parting axis andthe interface between the two mold halves is often planar, or at leastsubstantially planar, and is often called a “parting plane”. In at leastone such instance, the parting plane is perpendicular to the axis of aclip trough of the clip applier jaws formed within the injection mold.Such an arrangement allows stiffening features, such as a rail, forexample, to be designed onto the back side of the clip applier jaws,friction or holding features within the clip trough, and/or the distalholding features discussed above, for instance. Using a MIM process mayoften require the clip applier jaws to be machined, ground, and/orpolished, for example, after being removed from the injection mold. Theclip applier jaws are then either pivotally pined together and/or weldedpivotally to the connection features of an end effector. By using MIM toproduce certain portions of the jaws, the cost to produce the jaws canbe reduced as inexpensive manufacturing methods can be utilized for theconnection features, as opposed to using MIM to produce the entire clipapplier jaws. Further, the clip applier jaws can be independentlymanufactured using MIM and then welded to a spring based interconnectionclip. Moreover, independently manufactured clip applier jaws that arethereafter assembled together allows for the clip applier jaws to have ametallic clip guidance track to be built into the lateral inside facingportion of the clip applier jaws. The independently manufactured clipapplier jaws using MIM may further comprise distal clip retentionfeatures, such as ledges, for example, which prevent the unintentionalejection of a clip from the distal end of the clip applier jaws. Suchdistal clip retention features can extend above the primary face of theclip applier jaws owing to these MIM processes.

As discussed above, and as described in greater detail below, certainclip appliers are configured to be inserted into a patient through apassage defined in a trocar. That said, the clip jaws of many clipappliers are wider than the trocar passage when they are in their openconfiguration. Described below are various systems that can beincorporated into a clip applier to facilitate the insertion of the clipapplier through the trocar passage.

Referring to FIG. 69, a graph 71000 depicts the movements of a cammember and a feeder/firing member of a clip applier, such as the clipapplier 70100, for example. The cam member is similar to cam member70180 and the feeder shoe is similar to firing member 70165 illustratedin FIGS. 35A-38, for example. In order to configure the clip applier70100 in a trocar-insertion configuration, the cam member is moved to afully advanced position to close the jaws of the clip applier and thefeeder shoe is moved to a fully retracted position. In variousinstances, the clip applier comprises a control system including abutton which, when depressed, places the clip applier in itstrocar-insertion configuration. In at least one instance, the controlsystem operates the one or more electric motors of the clip applier toconfigure the drive systems as described above. At such point, the clipapplier is ready to be inserted into the patient through the trocar.Once inserted into the patient, the button can be pressed again and, inresponse thereto, the control system will retract the cam member to afully retracted position and open the jaws of the clip applier. Thisbutton can be pressed repeatedly to toggle the configuration of the clipapplier as needed. Such an arrangement is also useful to remove the clipapplier from the patient through the trocar. The reader shouldappreciate that the opening and closing of the jaws via the button willnot affect the other functions of the clip applier such as advancing aclip, forming a clip, and/or ejecting a clip from the clip magazine.

Once the clip applier has been inserted through the trocar and thebutton has been actuated a second time (i.e., the jaws are open),further to the above, a firing button can be pressed resulting in thefeeder shoe advancing to a fully advanced position. A clip will beadvanced with the feeder shoe as described above in relation to clipapplier 70100 (FIGS. 35A-38), for instance. The feeder shoe can then beretracted to a fully retracted position and the cam member can beadvanced to the fully advanced position to form the clip around tissueof the patient, as also described above. The cam member can then beretracted to the fully retracted position to release the clip and thetissue. Once all of the clips have been applied, or at least asufficient number of clips have been applied, the button could beactuated again to close the jaws to allow the clip applier to be removedthrough the trocar. Such an arrangement enables the user of the clipapplier to close the jaws without releasing a loose clip into thepatient.

Further to the above, embodiments are envisioned where a clip appliercomprises a motor and a motor controller. The motor controller can beconfigured to control the motor via a processor and a memory. The motorcontroller can implement motor control algorithms to configure the jawsto open and close as well as advance a clip into the jaws. For example,a motor control algorithm can be implemented to allow the jaws toadvance a clip into a crimping and/or forming position, as describedabove, after the jaws have been inserted through the trocar. By notfeeding a clip into the jaws until after the clip applier has beenintroduced into the patient, the jaws can be moved into a very compactarrangement when being inserted through the trocar as discussed above.

Turning now to FIG. 70, a graph 71100 depicts the movements of a cammember and a feeder shoe of a clip applier comprising a rotating clipmagazine (i.e., a barrel magazine), such as the clip applier 70600, forexample. The operation of the clip applier depicted in FIG. 70 issimilar to that of clip applier 70600 in many respects. For example, thecam member is similar to closure tube 70620, the feeder shoe is similarto feeder member 70630, and the barrel magazine is similar to rotatableclip magazine 70650 illustrated in FIGS. 52-60, for example. The clipapplier is placed into the patient through a trocar with the jaws closedand a clip positioned in the jaws and another clip aligned with thefeeder shoe for deployment out of the barrel magazine. With the feedershoe in the home position (i.e., zero displacement) the cam member canbe advanced to a fully advanced position from the home position to crimpthe clip already placed within the jaws. In at least one instance, thedistance between the home position and the fully advanced position is0.3″, for example. The cam member is then retracted to a partiallyadvanced position just proximal to the fully advanced position to reducethe force applied to the clip by the jaws. The cam member is advancedagain to the fully advanced position to crimp the clip again. Byapplying a force, reducing that force, and then applying the same, oranother, force again, the elasticity within the clip can be reduced suchthat full plastic deformation can occur to properly crimp the clip ontothe patient tissue. The partially advanced position is dependent on thetype of clip being utilized with the clip applier. For example, thepartially advanced position is preferably 0.2″ distal from the homeposition for a clip with a clip opening of 0.210″ and is preferably0.23″ distal from the home position for a clip with a clip opening of0.180″, for example. Suitable thresholds can be set by the userdepending on the type of clips in the barrel magazine being utilizedwith the clip applier. Other embodiments are envisioned with differentclip sizes and position arrangements for the partially retracted andfully advanced positions.

In any event, after the clip has been properly crimped, the cam memberis then retracted proximally toward the home position as the feeder shoedistally advances a clip out of the barrel magazine toward the jaws ofthe clip applier into a pre-form position when the feeder shoe is 0.08″distal from the home position, for example. When the clip is in thepre-form position, the jaws can be partially opened by retracting thecam member slightly beyond the home position, i.e., the cam memberinteracts with the jaws of the clip applier to open the jaws when thecam member is retracted proximal to the home position, as discussedabove. Such an arrangement allows the clip to be expanded by thepre-form features on each of the jaws (i.e., protrusions 70608) asdiscussed above. The feeder shoe then distally advances the clip furtherinto a crimping position—0.3″ distal to the home position, for example.Once the feeder shoe is advanced beyond the barrel magazine (i.e., tothe pre-form position) the barrel magazine can be cycled (i.e., rotated)to position another clip for advancement into the jaws. The barrelmagazine is cycled by retracting the cam member to a fully retractedposition—0.05″ proximal to the home position, for example. The cycledclip will be biased against the feeder shoe which prevents the clip frombeing completely ejected from the barrel magazine. Once the feeder shoeis retracted to the home position the cycled clip can be displayed(i.e., the biasing member in the barrel magazine can now position thecycled clip into alignment with the feeder shoe because the feeder shoehas been retracted and is no longer blocking such movement). At thispoint a clip that has been pre-formed is positioned in the jaws andanother clip is aligned with the feeder shoe for deployment out of thebarrel magazine into the clip applier jaws, just as when the clipapplier was first inserted into the patient. The same operationsdiscussed above can be performed until all of the clips in the barrelmagazine are spent.

A graph 71200 of a firing member of a clip applier, such as any of theclip appliers described herein, for example, is illustrated in FIG. 71.The graph 71200 shows the relationship between the force required toadvance a clip within the clip applier (i.e., via the firing member)versus displacement. With further reference to FIG. 71, a graph 71300 ofthe same clip applier is illustrated showing the relationship betweenthe voltage applied to the motor driving the firing member of the clipapplier versus time. The motor controller of the clip applier canmonitor the current being drawn by the motor and/or the force beingapplied to the firing member by the motor to detect a clip feed jam, oran irregular force within the clip applier, and then prevent furtheradvancement of the firing member by implementing changes to the voltageapplied to electric motor, as seen in graph 71300. In other words, ifthe monitored force exceeds a threshold value, and/or the monitoredmotor current exceeds a threshold value, during the clip feed step, themotor controller can, one, reduce the magnitude of the voltage potentialbeing applied to the motor for a period of time and, two, further assessthe force within the firing system and/or further assess the electricalcurrent being drawn by the motor. If the force and/or motor currentcontinue to increase with the continued application of voltage to themotor, the motor control system can stop the motor and/or reverse thedirection of the motor shaft to retract the firing member through ashort stroke distance to clear the jammed clip. Once the jammed clip iscleared, the clip applier can return to its normal operation and preparethe next clip to be advanced in accord with the normal operatingsequence of the clip applier.

Other embodiments are envisioned where clearing the jammed clip isaccomplished by interrupting the normal sequence of the end effector jawoperations. More specifically, once the clip jam is detected the controlsystem of the clip applier (i.e., motor controller, processor, andmemory) could request the clinician initiate a jam removal actuation.The jam removal actuation results in the jaws of the clip applier beingopened further than normal prior to another attempt to re-advance theclip. During the attempt to re-advance the clip, the acceptable loadthreshold, i.e., the current threshold and/or the force threshold, couldbe elevated above the normal thresholds previously discussed to insurethe clip is ejected from the jaws. Once the jammed clip has beenejected, the clip applier could return to its normal operation andprepare the next clip to be advanced in accord with the normal operatingsequence of the clip applier.

As mentioned above, certain clip appliers can be loaded with clipshaving a first size and/or a second size. The relative size of the clipscan be measured using any suitable dimension, such as the leg-to-legwidth of the clips, for example. First clips having a first width can bewider than second clips having a second width. In various instances, theclip applier can be loaded with only first clips, only second clips, orboth first and second clips at the same time. In any event, clips havingdifferent sizes may deform differently for a given closure stroke of theclip jaws. Thus, for instance, a first closure stroke of the clip jawsmay be more preferable for the first clips while a second closure strokeof the clip jaws may be more preferable for the second clips. Many ofthe clip appliers disclosed herein are capable of selectively applyingmore than one closure stroke to the clip jaws; however, in order toapply the correct closure stroke to a clip, the clip applier needs to beable to assess which size of clip is positioned within the clip jaws. Incertain instances, such information can be manually entered into thecontrol system of the clip applier by the clinician. Such an arrangementis convenient when the clips in the clip applier all have the same size.In various instances, the clip cartridge attached to the clip appliercomprises a marker, such as a microchip, for example, which can beevaluated by the control system and/or a sensor circuit in communicationwith the control system, for example. Such an arrangement is convenientwhen the clips in the clip cartridge all have the same size.

In various instances, further to the above, the clip applier can beconfigured to assess the clip positioned between the clip jaws of theclip applier to assess the size of the clip. Once a clip is loadedbetween the clip jaws, the control system can partially operate the jawclosure drive and observe the force within the jaw closure drive and/orthe current drawn by the electric motor of the jaw closure drive. Thecontrol system is configured to compare the measured data to data storedin a memory device, for example, to assess whether the clip between theclip jaws is a first clip or a second clip, or any other clip. Forinstance, if the measured force and/or motor current follows a firstprofile, then the control system will determine that the clip is a firstclip and then apply the first closure stroke. Similarly, the controlsystem will apply the second closure stroke if the measured force and/ormotor current follows a second profile for the second clip. As such, thecontrol system can use the jaw closure drive to apply a short evaluationclosure stroke to assess the clip size and then complete the fullclosure stroke as appropriate. In at least one instance, the controlsystem can reset the jaw closure drive after performing the shortevaluation closure stroke and then complete a full closure stroke asappropriate. In various instances, it is envisioned that the shortevaluation closure stroke does not plastically deform, or at leastsubstantially plastically deform, the clip.

Referring to FIG. 72, a graph 71400 of the force applied to a pair ofjaws of a clip applier versus time is illustrated. The control system ofthe clip applier can monitor the force within the crimping drive and/orthe electric current drawn by the motor to determine the amount of forceneeded to crimp a clip positioned within the jaws of the clip applier.This feedback force is initially dependent on the size and/or type ofclip that is within the jaws for a first portion of the closure strokeof the jaws. Once the size/type of clip is determined, the force appliedto the jaws of the clip applier can be adjusted for the remainder of thejaw closure stroke to crimp the clip with the proper amount of force.Such an arrangement is convenient when more than one size of clip hasbeen loaded into the clip applier. Other embodiments are envisionedwhere an adaptive control program change is initiated by the cartridgeidentifying itself to the clip applier upon insertion into the clipapplier. This allows the clip applier to update to the alternativecontrol program and thresholds (i.e., the forces applied to the jaws)for the size/type of clip loaded into the clip applier. Further, analternative to the identification of the cartridge could be thedetection of the loads needed to accomplish the first job of the clipapplier, which could be the advancement of a clip from the cartridge orpre-forming a clip within the jaws as discussed above. The first job ofthe clip applier may have a significantly higher load threshold neededto complete the operation and exceeding that threshold, or not, willthen determine the subsequent operations the clip applier and thethreshold limits of each operation.

Many of the clip appliers discussed herein have been discussed in thecontext that the clip jaws of the clip appliers are squeezed to crush aclip into its proper size. Other embodiments are envisioned in which aclip is elastically or resiliently stretched and then released once thetargeted tissue has been positioned within the stretched clip. Such anarrangement can be particularly useful when clamping or clipping bloodvessels, for example. In such instances, a clip can be released toresiliently return to, or at least toward, its unstretched position andclamp the blood vessel in an atraumatic, or a nearly atraumatic, manner.All of the clip appliers disclosed herein can be adapted to apply suchstretch-and-release clips. Moreover, further to the above, the clipappliers disclosed herein can be configured to apply both theclamp-to-crush clips and the stretch-and-release clips. Similar to theabove, the clip appliers would need to be able to identify the type ofclips contained therein in order to apply them properly to the patienttissue. Identification chips in the clip cartridges could be used forsuch purposes, for example.

FIG. 75 depicts a clip applier system 71500 in accordance with at leastone embodiment. The clip applier system 71500 comprises the clip applier70600 discussed above. The clip applier system 71500 further comprises amagnet aligned with one of the clips 70654 of the rotatable clipmagazine 70650. The clip applier system 71500 further comprises asensor, such as a Hall Effect sensor 71502, for example, fixedlypositioned within the ground portion 70612 of the clip applier 70600.The magnet can be sensed by the Hall Effect sensor 71502 and, based onthe voltage potential created by the Hall Effect sensor, the controlsystem of the clip applier 71500 can determine the radial location andorientation of the magnet and, thus, the radial location and orientationof the clip magazine 70650. When the magnet is in a first position71504, referring to FIG. 76, the rotatable clip magazine 70650 is loadedwith a full compliment of clips 70654 and one of the clips 70654 can beadvanced out of the rotatable clip magazine 70650 into the end effector70605. The rotatable clip magazine 70650 can then be cycled (e.g.,rotated) as discussed above, causing the magnet to move between thefirst position 71504 and a second position 71506. Another clip 70654 canbe advanced out of the rotatable clip magazine 70650 and the rotatableclip magazine 70650 can be cycled again, causing the magnet to move to athird position 71508. Another clip 70654 can be advanced out of therotatable clip magazine 70650 and the rotatable clip magazine 70650 canbe cycled again, causing the magnet to move to a fourth position 71510.Further, another clip 70654 can be advanced out of the rotatable clipmagazine 70650 and the rotatable clip magazine 70650 can be cycledagain, causing the magnet to move to a fifth position 71512. In thefifth position 71512, the last clip 70654 in the rotatable clip magazine70650 can be advanced out of the rotatable clip magazine 70650. Thus,the clip applier system 71500 can determine the status of the clipmagazine 70650 (i.e., the number of clips remaining) depending on theposition of the magnet relative to the Hall Effect sensor 71502. Furtherto the above, FIG. 76 depicts the voltage potential generated by theHall Effect sensor 71502 depending on the position of the magnet.

In at least one alternative embodiment of the clip applier system 71500,the clip magazine 70650 further comprises an extension member, or bar,that extends proximally from the clip magazine 70650 once all of theclips 70654 have been ejected from the clip magazine 70650. Theextension member is sensed by the Hall Effect sensor 71502 and/oranother electrical sensor within the clip applier 70600. When theextension member is detected by the clip applier system 71500, themechanical systems (i.e., the feeder member 70630, firing member 70640,and drive tube 70620) of the clip applier 70600 can be locked out toprevent further actuation.

FIG. 77 depicts a clip applier 71600. The clip applier 71600 comprises afirst jaw 71610 a and a second jaw 71610 b moveable relative to eachother between open and closed positions. The clip applier 71600 isconfigured to receive a clip 71604 which is crimped by the first jaw71610 a and the second jaw 71610 b when the first jaw 71610 a and thesecond jaw 71610 b are moved toward the closed position. The clipapplier 71600 comprises a resistive sensing circuit configured todetermine the position of the clip 71604 within the clip applier 71600.The resistive sensing circuit comprises a supply voltage source 71602which supplies current through a first lead 71620 a, the first jaw 71610a, the clip 71604, the second jaw 71610 b, and a Resistor 71620 b andback to a return 71606 where the current can be measured. When the clip71604 is moved distally though the clip applier, such as to the positionshown by clip 71604′, for example, the path through which the currentflows is larger (i.e., larger than the path for clip 71604) and theresistance within the path is greater and, as a result, the currentmeasured at the return 71606 will be smaller. Thus, the current measuredat the return 71606 is directly proportional to the position of the clip71604 within the clip applier 71600. The control system of the clipapplier is configured to use the magnitude of the current in thissensing circuit to assess the position of the clip 71604′ within thejaws 71610 a and 71610 b. Higher current magnitudes indicate that theclip 71604′ is more proximal and lower current magnitudes indicate thatthe clip 71604's is more distal, while intermediate current magnitudesindicate that the clip 71604′ is positioned in the middle of the jaws71610 a and 71610 b.

Referring still to FIG. 77, the clip applier 71600 further comprises asecond resistive sensing circuit configured to determine when the firstjaw 71610 a and the second jaw 71610 b are in the closed position. Morespecifically, the supply voltage supplies current which flows through afirst lead 71630 a connected to the first jaw 71610 a. The first lead71630 a is insulated from the first jaw 71610 a, i.e., it does not allowcurrent to flow into the first jaw 71610 a. When the first jaw 71610 aand the second jaw 71610 b are in the closed position, the first lead71630 a contacts a second lead 71630 b connected to the second jaw 71610b which allows current to flow into a resistor 71630 c and into thereturn 71606 where the current can be measured. The second lead 71630 bis also insulated from the second jaw 71610 b. Thus, when the first jaw71610 a and the second jaw 71610 b are in the closed position, thecontrol system, via the return, will sense a current determined by asecond resistance through the resistor 71630 c which indicates that thefirst and second jaws 71610 a, 71610 b are in the closed position. Thecontrol system may, at the same time, also sense the resistance throughresistor 71620 b which indicates the position of the clip 71604 withinthe clip applier 71600. Other embodiments are envisioned where only oneof the resistive sensing circuits discussed above are utilized with theclip applier 71600.

FIGS. 78A and 78B depict a variable resistance system for use with aclip applier 71650 configured to gather information (i.e., data) on theposition of the clip jaws and the formation of the clip during acrimping stroke. The clip applier 71650 is similar to clip applier71600, for example, in many respects. The clip applier 71650 comprises afirst jaw 71650 a and a second jaw 71650 b moveable relative to eachother between an open position (FIG. 78A), a partially closed position(FIG. 78B) and a closed position. The clip applier 71650 is configuredto receive a clip 71654 which is crimped by the first and second jaws71650 a, 71650 b when the first and second jaws 71650 a, 71650 b aremoved toward the closed position. The legs of the clip 71654 positionedwithin the first and second jaws 71650 a, 71650 b extend outwardly intoengagement with the first and second jaws 71650 a, 71650 b to ensure theclip 71654 is properly seated therebetween (i.e., so there is no slop orplay between the clip 71654 and the first and second jaws 71650 a, 71650b). In various instances, the legs of the clip are slightly deflectedinwardly when the clip is fed into the first and second jaws 71650 a,71650 b. The variable resistance system of the clip applier 71650 isdescribed in further detail below.

The variable resistance system comprises three return paths throughwhich an electrical current can flow and be sensed by the control systemof the clip applier in order to determine the position of the first andsecond jaws 71650 a, 71650 b relative to each other, and to sense theformation of the clip 71654. The first return path 71660 comprises thesecond jaw 71650 b. The second return path 71670 comprises a variableresistor configured to determine the position of the first jaw 71650 aand the second jaw 71650 b relative to each other. More specifically, asthe first jaw 71650 a and the second jaw 71650 b are moved from the openposition (FIG. 78A) toward the closed position the resistance in thevariable resistor will change. The third return path 71680 comprisesanother variable resistor at the distal end of the second jaw 71650 bwhich is insulated from the second jaw 71650 b. When the first jaw 71650a and the second jaw 71650 b are in the open position (FIG. 78A), theclip 71654 is in contact with the first return path 71660 and the thirdreturn path 71680. When the first jaw 71650 a and the second jaw 71650 nare in the partially closed position (FIG. 78B), the clip 71654 is onlyin contact with the first return path 71660. When the first jaw 71650 aand the second jaw 71650 b are in the closed position the clip 71654 hasbeen fully crimped and is once again in contact with the first returnpath 71660 and the third path 71680. Throughout the movement of thefirst jaw 71650 a and the second jaw 71650 b between the open position,the partially closed position, and the closed position, the secondreturn path 71670 determines the position of the first jaw 71650 arelative to the second jaw 71650 b. Thus, the variable resistance systemcan determine jaw position and sense clip formation throughout the clipformation process by determining the resistance through each of thethree paths.

FIG. 79 depicts a clip applier jaw 71700 in accordance with at least oneembodiment. The clip applier jaw 71700 is configured to move toward andaway from another clip applier jaw and is further configured to crimp aclip as discussed above in relation to various embodiments disclosedherein. The clip applier comprises a proximal strain gauge 71720 and adistal strain gauge 71730, and/or any number of suitable strain gauges.The proximal strain gauge 71720 and the distal strain gauge 71730 arepositioned on a face 71710 of the clip applier jaw 71700. Otherembodiments are envisioned with more than two strain gauges spaced alongany suitable face of the clip applier jaw 71700 and/or built into theclip applier jaw 71710 itself. The proximal strain gauge 71720 is partof a proximal strain gauge circuit and generates a voltage signalindicative of the strain within the clip applier jaw 71700 in a firstlocation and the distal strain gauge 71730 is part of a distal straingauge circuit and generates a voltage signal indicative of the strainwithin the clip applier jaw 71700 in a second location. The proximal anddistal strain gauge circuits are in communication with the controlsystem of the clip applier and, as a clip is formed between the clipapplier jaw 71700 and another clip applier jaw, different levels ofstrain will be detected by the control system at the first location andthe second location.

Referring to FIG. 80, a graph 71800 of the strain (measured in Volts,but could be more conveniently illustrated in mV) within the proximalstrain gauge 71720 and the distal strain gauge 71730 at various stagesof clip formation is depicted. Upon the initial placement of a clipbetween the clip applier jaws, the clip legs of certain clips are biasedoutwardly into engagement with the jaws, as discussed above. In suchinstances, a larger strain may be measured in the proximal strain gauge71720 as compared to the distal strain gauge 71730. The difference inthe voltages within the strain gauges 71720, 71730 at this stage isvoltage A as depicted in FIG. 80. As the jaws of the clip applier beginto form the clip, the reading from the proximal strain gauge 71720 willexceed a pre-formed strain threshold T_(PF) while the reading from thedistal strain gauge 71730 remains below the pre-formed strain thresholdT_(PF). This can indicate that the clip has only been formed at or nearthe proximal strain gauge 71720. The difference in the voltages betweenthe readings of the strain gauges 71720, 71730, at this stage, ismeasured to be A′. As the jaws of the clip applier form the clipfurther, the reading from the distal strain gauge 71730 will eventuallyexceed the pre-formed strain threshold T_(PF) and the reading from theproximal strain gauge 71720 will eventually exceed a full-formed strainthreshold T_(FF). This can indicate that the clip has been fully formedat or near the proximal strain gauge 71720 and has begun to be deformedat or near the distal strain gauge 71730. When the readings from theproximal strain gauge 71720 and the distal strain gauge 71730 are bothmeasured to be beyond the full-formed threshold T_(FF) and thepre-formed threshold T_(PF), respectively, the difference in the straingauge readings is measured as A″ as depicted in FIG. 80. Further, as thejaws of the clip applier form the clip further, the reading from thedistal strain gauge 71730 will eventually exceed the full-formed strainthreshold T_(FF) and the reading from the proximal strain gauge 71720will continue to increase above the full-formed strain threshold T_(FF).When the reading from the proximal strain gauge 71720 and the distalstrain gauge 71730 are measured to both be beyond the full-formedthreshold T_(FF), the difference in the strain gauge readings ismeasured as A′″ as depicted in FIG. 80.

Further to the above, the state of the clip can be determined bymeasuring the differences between the readings of the proximal straingauge 71720 and the distal strain gauge 71730 throughout the formationof a clip. More specifically, a difference in voltage measuring Aindicates that the clip has yet to be deformed. A difference in voltagemeasuring A′ indicates that only a proximal portion of the clip has beendeformed. A difference in voltage measuring A″ indicates that theproximal portion of the clip has been fully formed and the distalportion of the clip has begun to be deformed. And lastly, a differencein the voltage measuring A′″ indicates that both the proximal and distalportions of the clip have been fully formed.

As discussed above, a clip applier is often inserted into a patientthrough a trocar. As a result, the diameter of the passageway throughthe trocar dictates a lot of the design considerations of the clipapplier—especially of the portions of the clip applier that are insertedthrough and/or into the trocar passageway. That said, there is oftenmotivation to make trocars as narrow as possible to reduce the size ofthe incisions in the patient, among other reasons. As such, narrowtrocars, and narrow trocar passageways, present significant designconstraints and often limit the widths of the clips that can be used.With this in mind, clip appliers are disclosed herein which areconfigured to store the clips in a small configuration and then enlargethe clips once they are on the other side of the trocar. Such anarrangement can allow clips to be used which, in their enlarged state,exceed the diameter of the trocar that they were inserted through.

FIGS. 81A and 81B depict a clip applier 71900 in accordance with atleast one embodiment. The clip applier 71900 comprises a first jaw 71910a and a second jaw 71910 b moveable relative to each other about a pivotpin 71912 between a closed position, a home position (FIG. 81A), and anopen position (FIG. 81B). The clip applier 71900 further comprises a cammember 71920 configured to move the first jaw 71910 a and the second jaw71910 b between the closed position, the home position, and the openposition. More specifically, the first jaw 71910 a and the second jaw71910 b are moved to the open position by the cam member 71920 when thecam member 71920 is moved to a fully retracted position (FIG. 81B) dueto the cam member 71920 engaging a first jaw cam 71914 a on the firstjaw 71910 a and a second jaw cam 71914 b on the second jaw 71910 b.Furthermore, the first jaw 71910 a and the second jaw 71910 b are movedto the home position by the cam member 71920 when the cam member 71920is moved distally to a home position depicted in FIG. 81A (i.e., the cammember 71920 is no longer engaging the first jaw cam 71914 a and thesecond jaw cam 71914 b allowing the first jaw 71910 a and the second jaw71910 b to assume the home position). Further still, the first jaw 71910a and the second jaw 71910 b are moved to the closed position by the cammember 71920 when the cam member 71920 is moved distally to a fullyadvanced position due to the cam member 71920 cammingly engaging theouter surfaces of the first jaw 71910 a and the second jaw 71910 b. Thefirst jaw 71910 a and the second jaw 71910 b are configured to receive aclip 71904 therein to be expanded during a pre-form operation andcrimped during a crimping operation. FIG. 81A depicts the clip 71904 ina storage configuration when the first jaw 71910 a and the second jaw71910 b are in the home position. The clip 71904 can be a 5 mm clip inthe storage configuration, for example. Expansion of the clip 71904during the pre-form operation and crimping of the clip 71904 during thecrimping operation are described in further detail below.

The first jaw 71910 a and the second jaw 71910 b comprise pre-formingfeatures, or protrusions 71930 a and 71930 b, similar to protrusions70126 a and 70126 b discussed above. The protrusions 71930 a and 71930 bengage the inner surfaces of the clip 71904 and expand the clip 71904from the storage configuration (FIG. 81A) to a firing configuration(FIG. 81B) when the first jaw 71910 a and the second jaw 71910 b aremoved to the open position. For example, the clip 71904 is expanded fromthe storage configuration where the clip 71904 has an approximately 5 mmwidth to a firing configuration where the clip 71904 has anapproximately 10 mm width. That said, a clip can have any suitablestored width and any suitable expanded width. After the clip 71904 hasbeen expanded to the firing configuration, a firing member advances theclip over the protrusions 71930 a, 71930 b into a crimping positionwithin the first jaw 71910 a and the second jaw 71910 b. The protrusions71930 a and 71930 b comprise angled portions which allow the clip 71904to slide over the protrusions 71930 a and 71930 b when advanced by thefiring member. Once a clip is in the crimping position, the cam member71920 is advanced distally to the fully advanced position during acrimping stroke to move the first jaw 71910 a and the second jaw 71910 bto the closed position, and, thus, crimp the clip 71904 within thecrimping chamber.

Further to the above, the clip applier 71900 further comprises a sensorarray 71940 that detects a magnet 71950 included in one of the first jaw71910 a and the second jaw 71910 b. The sensor array 71940 detects thelocation of the magnet 71950 relative to the sensor array 71940 in orderto determine the position of the first jaw 71910 a and the second jaw71910 b relative to each other during the operation of the clip applier71900.

As discussed herein, clip appliers are loaded with clips in a variety ofmanners. For instance, clips can be loaded into a clip applier by way ofa clip cartridge. Such clip cartridges can comprise clips stacked alonga longitudinal axis, for example. Such clip cartridges can also compriseclips stacked along an axis which is transverse to the longitudinal axisof the clip applier. Certain cartridges are stored in a circumferentialconfiguration, as described above. That being said, some clip appliersmay be configured to hold only one clip at a time. The teachingsprovided herein are adaptable to such clip appliers. In at least oneinstance, a one-clip clip applier, for example, can be used with adocking station comprising a plurality of clips stored therein. In suchinstances, the clinician can use the docking station to re-supply a clipto the one-clip clip applier after each use of the clip applier. Incertain instances, the docking station can be positioned in the patientwhich prevents the need to remove the clip applier from the patient suchthat the clip applier can be reloaded. In at least one instance, asdiscussed below, the docking station can be attached to a trocarinserted into the patient, for example. The above being said, the ideaof a docking station positioned within a patient can also be used with amulti-clip clip applier. In such instances, one or more clips from thedocking station can be loaded into the multi-clip clip applier withouthaving to remove the clip applier from the patient.

Turning to FIGS. 82 and 83, a clip applier system 72000 is depicted. Theclip applier system comprises a trocar 72010, a clip magazine 72050, anda clip applier 72020. The clip applier 72020 comprises an elongate shaft72011 extending from a housing, an articulation joint 72022 extendingfrom the elongate shaft 72011, and an end effector 72024 extending fromthe articulation joint 72022. The end effector 72024 comprises a firstjaw 72024 a and a second jaw 72024 b moveable relative to each otherbetween an open position and a closed position. The end effector 72024is articulable relative to the elongate shaft 72011 about thearticulation joint 72022. The clip magazine 72050 comprises an opening72051 (see FIG. 82) through the clip magazine 72050. Prior to insertionof the clip applier 72020 through the trocar 72010, the clip magazine72050 is positioned within the patient and attached to the distal end ofthe trocar 72010. The opening 72051 allows the clip magazine 72050 to bereceived and attached to the distal end of the trocar 72010 as depictedin FIG. 83. The clip magazine 72050 can be threadably attached to thedistal end of the trocar 72010, for example. The clip applier 72020 isthen inserted through the trocar 72010 and the opening 72051 of the clipmagazine 72050 until the end effector 72024 of the clip applier 72020 ispositioned distal to the clip magazine 72050. As the clip applier 72020is retracted toward the clip magazine 72050, the clip applier 72020engages the clip magazine 72050 to eject a clip from the clip magazine72050 into the end effector of the clip applier 72020, as discussed ingreater detail below.

Turning to FIGS. 85A and 85B, the clip magazine 72050 further comprises,a leaf spring 72052, a plurality of clips 72054 removably stored in theclip magazine 72050, a spring 72059, a sled 72058, and a loading arm72056. The leaf spring 72052 prevents the clips 72054 from falling outof the clip magazine 72050 inadvertently. The spring 72059 biases thesled 72058 distally to bias the clips 72054 toward the loading arm72056. The loading arm 72056 grasps and holds a clip 72054 in placeuntil acted upon by the clip applier 72020. To this end, the loading arm72056 engages a jaw wing 72026 of the clip applier 72020 as the clipapplier 72020 is retracted towards the clip magazine 72050 (i.e.,proximally). When the jaw wing 72026 is engaged by the loading arm72056, the jaw wing 72026 moves proximally and the loading arm 72056rotates toward the end effector 72024 to load a clip 72054 from the clipmagazine 72050 into the end effector 72024 of the clip applier 72020.FIGS. 84A-84C depict the movements of the jaw wing 72024 and the loadingarm 72056 as the clip applier 72020 is retracted towards the clipmagazine 72050. After a clip 72054 has been loaded into the end effector72024, the clip applier 72024 can be moved distally to a desiredlocation within the patient to crimp the clip 72054 around patienttissue. After the clip 72054 is crimped and released, the clip applier72020 can be retracted toward the clip magazine 72050 (i.e., proximally)to engage the jaw wing 72026 with the loading arm 72056 of the clipmagazine 72050 to load another clip into the clip applier 72020. Thisprocess can be repeated until all of the clips 72054 have been depletedfrom the clip magazine 72050, and/or until a suitable number of clipshave been applied.

Turning now to FIGS. 86A and 86B, the relationship between the jaw wing72026 and the first and second jaws 72024 a and 72024 b of the clipapplier 72020 is depicted. The jaw wing 72026 is operably engaged withthe first and second jaws 72024 a and 72024 b such that, when the firstand second jaws 72024 a and 72024 b are in the closed position (FIG.86B), the jaw wing 72026 is retracted. To this end, the clip applier72020 can be inserted through the clip magazine 72050 without the jawwing 72026 engaging the loading arm 72056 of the clip magazine 72050.Other embodiments are envisioned where the clip applier 72020 engagesthe clip magazine 72050 to load a clip 72054 into the end effector 72024when the clip applier 72020 is moved from a proximal position behind theclip magazine 72050 to a distal position beyond the clip magazine 72050.

A clip applier 73000 is depicted in FIGS. 87A-87D. The clip applier73000 comprises an elongate shaft 73010 extending from a housing, anarticulation joint 73020 extending from the elongate shaft 73010, amagazine housing 73030 extending from the articulation joint 73020, andan end effector 73040 extending from the magazine housing 73030. The endeffector 73040 comprises a first jaw 73040 a and a second jaw 73040 bmoveable relative to each other between an open position and a closedposition. The magazine housing 73030 comprises a bottom housing 73030 band a top housing 73030 a. The top housing 73030 a is movable relativeto the bottom housing 73030 b between an open position (FIG. 87A) and aclosed position (FIG. 87C) about a pivot pin 73032 attached to thearticulation joint 73020. The magazine housing 73030 can receive a clipmagazine 73050 comprising a plurality of clips 73054 stored therein. Theclips 73054 are loaded into the clip magazine 73030 and are locked inplace by a biasing member, or leaf spring 73056. The leaf spring 73056prevents the clips 73054 from being ejected form the clip magazine 73050until the clip magazine 73050 is seated in the magazine housing 73030,as discussed in greater detail below.

The clip magazine 73050 further comprises notches 73058 on either sideof the clip magazine 73050. To properly seat the clip magazine 73050 inthe magazine housing 73030, the notches 73058 of the clip magazine 73050are aligned with protrusions 73034 of the magazine housing 73030 to seatand align the clip magazine 73050 in the magazine housing 73030 asdepicted in FIG. 87B. Once the clip magazine 73050 is installed into themagazine housing 73030, the top housing 73030 a can be moved to theclosed position as depicted in FIG. 87C. The top housing 73030 acomprises a lockout release, or protrusion 73032, that engages the leafspring 73056 of the clip magazine 73050 when the clip magazine 73050 isinstalled in the magazine housing 73030 and the top housing 73030 a isin the closed position as depicted in FIG. 87D. When the leaf spring73056 is depressed by the protrusion 73032, the clips 73054 are nolonger locked into position within the clip magazine 73050 and can beejected from the clip magazine 73050 into the end effector 73040 by afiring member.

Turning now to FIGS. 88A-88D, after all of the clips 73054 have beenejected from the clip magazine 73050, the clip magazine 73050 can belocked out when removed from the magazine housing 73030 to prevent theclip magazine 73050 from being re-installed into the magazine housing73030 until reloaded with at least one new clip 73054. Morespecifically, the clip magazine 73030 comprises a sled 73052 that movesthrough the clip magazine 73030 as the clips 73054 are ejected. The sled73052 comprises spring loaded detents 73059 which align with the notches73058 in the clip magazine 73050 when the last clip 73054 has beenejected form the clip magazine 73050. When the clip magazine 73050 isinstalled in the magazine housing 73030 and the clip magazine 73050 hasbeen spent, the spring loaded detents 73059 are biased against theprotrusions 73034 as depicted in FIGS. 88B and 88D. After the clipmagazine 73050 is removed from the magazine housing 73030, the springloaded detents 73059 protrude through the notches 73058 to lock the sled73052 into place as depicted in FIG. 88A. The spent clip magazine 73050cannot be re-installed into the magazine housing 73030 unless at leastone clip 73054 is loaded into the clip magazine 73050. Morespecifically, until the sled 73052 is retracted to disengage the springloaded detents 73059 from the notches 73058 (i.e., at least one clip73054 is installed) the clip magazine 73050 cannot be installed into themagazine housing 73030 because the spring loaded detents 73059 occupythe notches 73058 and will not allow the notches 73058 to properly alignand seat with the protrusions 73034 of the magazine housing 73030.

Other embodiments are envisioned where a clip applier system comprises aclip applier, a trocar, and a sensing system. The clip applier of theclip applier system is similar to clip applier 72020 in many respectsand the trocar is similar to the trocar 72010 in many respects. Thetrocar can comprise a sensor, such as a Hall Effect sensor, for example,attached to, or near, the distal end of the trocar. The clip applierfurther comprises a detectable element, such as a magnet, for example,positioned in the end effector of the clip applier. The magnet in theend effector of the clip applier and the Hall Effect sensor on thedistal end of the trocar are included in the sensing system. The sensingsystem is in signal communication with the control system of the clipapplier via a wireless signal transmitter in the trocar and a wirelesssignal receiver in the clip applier. The control system of the clipapplier is configured to automatically control the opening and closingof the jaws of the end effector depending on the position of the magnetrelative to the Hall Effect sensor. More specifically, when the magnetin the jaws is positioned a predetermined distance distal to the HallEffect sensor of the trocar—which indicates that the jaws have passedthrough the trocar, the clip jaws are automatically moved to an openposition by the control system of the clip applier. Moreover, thecontrol system of the clip applier can also automatically load a clipinto the open jaws. Such an arrangement reduces the time needed to loadthe clip applier after being inserted into a patient. Further, when themagnet in the jaws is approaching the Hall Effect sensor of the trocarfrom a distal position (i.e., the clip applier is being retractedproximally toward the trocar) the control system automatically moves thejaws to a closed position to allow the clip applier to be retractedthrough the trocar.

FIG. 89 depicts a clip applier 74000 in accordance with at least oneembodiment. The clip applier 74000 comprises an elongate shaft 74010extending from a housing, a clip reload 74020 comprising a plurality ofclips, a distal head 74030 rotatable relative to the housing, an endeffector 74040 extending from the distal head 74030, and an articulationjoint 74050 rotatably connecting the distal head 74030 and the elongateshaft 74010. The distal head 74030 is articulatable relative to theelongate shaft 74010 by an articulation bar 74052 that is operablyresponsive to a motor inside the housing of the clip applier 74000.Further, the clip reload 74020 is releasably attachable to the distalhead 74030 by way of an opening 74032 in the distal head 74030 and aprotrusion 74022 on the clip reload 74020. The protrusion 74022 extendsoutwardly and is captured by the opening 74032 to releasably attach theclip reload 74020 to the distal head 74030. The clip reload 74020 isinterchangeable with other clip reloads, for instance, the clip reload74020 can be interchanged with clip reloads containing clips that aresmaller or larger than the clips of clip reload 74020. This arrangementallows for different size clip reloads to be attached to the same distalhead, such as the distal head 74030, for example.

FIGS. 90A and 90B depict a distal head 74100 releasably attached to ashaft 74120 of a clip applier in accordance with at least oneembodiment. The distal head 74100 has an eight millimeter diameter andis for use with LIGAMAX 5 clips from Ethicon Inc. and the shaft 74120has an eight millimeter diameter shaft, for example. The distal head74100 is releasably attachable to the shaft 74120 by a detent 74105.Other embodiments are envisioned with different attachment mechanisms.The distal head 74100 comprises a proximal portion 74110 which extendsproximally from the distal head 74100 and comprises the detent 74105thereon. The proximal portion 74110 is configured to fit inside andalign with the shaft 74120 of the clip applier to facilitate properattachment of the distal head 74100 to the shaft 74120.

FIGS. 91A and 91B depict a distal head 74200 releasably attached to ashaft 74220 of a clip applier in accordance with at least oneembodiment. The distal head 74200 has a nine millimeter diameter and isfor use with ER320 clips from Ethicon Inc. and the shaft 74220 has aneight millimeter shaft diameter. The distal head 74200 is releasablyattachable to the shaft 74220 by a detent 74205. The distal head 74200comprises a proximal portion 74210 which extends proximally from thedistal head 74200 and comprises the detent 74205 thereon. The proximalportion 74210 is configured to fit inside and align with the shaft 74220of the clip applier to facilitate proper attachment of the distal head74200 to the shaft 74220.

FIGS. 92A and 92B depict a distal head 74300 releasably attached to ashaft 74320 of a clip applier in accordance with at least oneembodiment. The distal head 74300 is an eleven millimeter distal clipapplier head for use with ER420 clips and the shaft 74320 is an eightmillimeter shaft, for example. The distal head 74300 is releasablyattachable to the shaft 74320 by a detent 74305. The distal head 74300comprises a proximal portion 74310 which extends proximally from thedistal head 74300 and comprises the detent 74305 thereon. The proximalportion 74310 is configured to fit inside and align with the shaft 74320of the clip applier to facilitate proper attachment of the distal head74300 to the shaft 74320.

The distal heads 74100, 74200, and 74300 are of varying sizes asdescribed above, however, the distal heads 74100, 74200, and 74300 arereleasably attachable to the same size shaft (an eight millimeter shaft,for example).

FIG. 93A depicts a clip applier system 74400 in accordance with at leastone embodiment. The clip applier system 74400 comprises a clip appliershaft 74410 extending from a housing of the clip applier system 74400.The clip applier shaft 74410 is configured to selectively receivevarious distal heads, such as distal head 74450, or in the alternativedistal head 74460, for example. The clip applier shaft 74410 comprises aproximal shaft 74412 extending from the housing of the clip applier, adistal shaft 74420 comprising an opening 74422, and an articulationjoint 74415 connecting the proximal shaft 74412 and the distal shaft74420. The opening 74422 is configured to receiver protrusions 74452,74462 of the distal heads 74450 and 74460, respectively, depending onwhich distal head is attached to the clip applier shaft 74410. In atleast one embodiment, the distal heads 74450 and 74460 are differentsizes (e.g., in diameter and/or length) and are configured to storedifferent size clips, for example. Further, the distal head 74450comprises an end effector 74454 extending therefrom and the distal head74460 comprises end effector 74464 extending therefrom which havedifferent sizes and can form clips to different sizes. As a result ofthe above, the clip applier system 74400 comprises a clip applier shaft74410 configured to interchangeably connect different size distal headswith different size end effectors to the same size clip applier shaft74410.

FIG. 93B depicts a clip applier system 74470 in accordance with at leastone embodiment. The clip applier system 74470 comprises a distal head74472 configured to releasably attach to a shaft 74478 comprising arotary input 74479. The shaft 74478 extends from a housing of the clipapplier system 74470 and is operably responsive to rotary motionsgenerated by a motor within the housing. The distal head comprises acarriage 74474 and a drive screw 74477 threadably engaged with thecarriage 74474. The carriage 74474 is configured to translate relativeto the distal head 74472 when the distal head 74472 is attached to theshaft 74478. More specifically, the drive screw 74477 is threadablyengaged with a collar 74476 of the carriage 74474 and the carriage 74474is rotatably constrained within the distal head 74472 such that, as thedrive screw 74477 is rotated, the carriage 74474 will translate throughthe distal head 74472. The rotary input 74479 is configured to connectto the drive screw 74477 via a quick disconnect 74475 on the distal endof the rotary input 74479 when the distal head 74472 and the shaft 74478are brought together. Thus, the rotary input 74479 can rotate the drivescrew 74477 when they are attached. In at least one embodiment, theproximal end of the drive screw 74477 comprises a square shape (see FIG.93D) and the distal end of the rotary input 74479 comprises a squareopening configured to receive the square shape of the drive screw 74477to allow the transfer of rotational motions from the rotary input 74479to the drive screw 74477. Other embodiments are envisioned withdifferent mechanical connection types between the rotary input 74479 anddrive screw 74477 to allow the distal head 74472 and shaft 74478 toreleasably attach and rotate together.

Once the distal head 74472 is attached to the shaft 74478, the rotaryinput 74479 can be rotated to translate the carriage 74474 between aproximal position and a distal position within the distal head 74472.The thread pitch of the drive screw 74477 can be chosen to effectuate atranslation of the carriage 74474 through a stroke of a predeterminedlength. The predetermined length can be based on the distal headfunction that the translation of the carriage 74474 is performing, suchas feeding a clip through the distal head into an end effector orcrimping a clip within the end effector, for example. Further, thepredetermined length can be selected based on the size (e.g., diameteror length) of the distal head and/or the size of the clips to beadvanced and/or formed.

FIG. 93C depicts a clip applier system 74480 in accordance with at leastone embodiment. The clip applier system 74480 is similar to the clipapplier system 74470 in many respects. The distal head 74482 comprises acarriage 74484 rotatably constrained within the distal head 74482, andthe carriage 74484 comprises a collar 74486 configured to capture adrive screw 74487 of the distal head 74482. The drive screw 74487 isconfigured to releasably attach to the rotary input 74479 of the shaft74478 of the clip applier system 74470, similar to the above. Asillustrated in FIG. 93C, the distal head 74482 is larger than the distalhead 74472; however, the carriage 74484 of the distal head 74482 issized such that the drive screw 74487 and rotary input 74489 are alignedwhen the distal head 74482 is attached to the shaft 74478. Thus, thequick disconnect 74475 of the clip applier system 74470 is compatiblewith the drive screw 74487 of the clip applier system 74480. Similar tothe drive screw 74477 of the clip applier system 74470, the thread pitchof the drive screw 74487 can be selected to effectuate a translation ofthe carriage 74484 through a stroke of a predetermined length. Thepredetermined length can be based on the distal head function that thetranslation of the carriage 74484 is performing, such as feeding a clipthrough the distal head 74482 into an end effector or crimping a clipwithin the end effector, for example. Further, the predetermined lengthcan be selected based on the size (e.g., diameter and/or length) of thedistal head and/or the size of the clips to be advanced or formed.

FIG. 94 depicts a clip magazine 74500 of a clip applier in accordancewith at least one embodiment. The clip magazine 74500 is rotatable abouta magazine axis MA. The clip magazine 74500 is configured to removablestore a plurality of clips, such as inner clips 74501, 74503, 74505 andouter clips 74502, 74504, 74506, for example. The clip magazine 74500comprises an outer housing 74510 with the plurality of clips removablystored therein. The clips are arranged in a radial array and spacedapproximately 120 degrees apart around the magazine axis MA. Further,the outer clips 74502, 74504, and 74506 are closest to the outer housing74510 and the inner clips 74501, 74503, 74505 are closest to themagazine axis MA. Each outer clip 74502, 74504, and 74506 is laterallyoffset from, and stacked on top of, a respective inner clip 74501,74503, and 74505. Each outer clip 74502, 74504, 74506 is centered on aclip axis CA, the clip axes CA are approximately 120 degrees apart, andeach inner clip 74501, 74503, 74505 is offset from its respective clipaxis CA. For example, the outer clip 74502 is stacked on top of theinner clip 74501, and the edges of the outer clip 74502 are offset fromthe edges of the inner clip 74501 (the outer clip 7502 is centered onthe clip axis CA and inner clip 74501 is not). When this arrangement isduplicated with the clip stacks at each 120 degree location, asillustrated in FIG. 94, the outer housing 74510 is smaller than a cliparrangement where the clip stacks are not offset, such as in FIG. 95A,for example. In other words, if the clips are stacked on top of oneanother with no lateral offset then the radial footprint of the clipswill be larger, absent other considerations. Other embodiments of cliparrangements within a clip magazine are envisioned and described below.

FIG. 95A depicts a clip magazine 74550 in accordance with at least oneembodiment. The clip magazine 74550 is configured to attach to and/orfit inside a clip applier shaft 74552 and is rotatable relative to theclip applier shaft 74552. The clip magazine 74550 comprises a pluralityof clips 74554 arranged in stacks and stored in the clip magazine 74550at storage locations 74556 that are radially spaced approximately 120degrees apart, for example. The storage locations 74556 are sized tokeep the edges of the clips 74554 aligned with one another. An opening74558 in the clip magazine 74550 allows an internal drive to passthrough the clip magazine 74550. The internal drive can advance a clip74554 out of the clip magazine 74550 into an end effector of the clipapplier and/or crimp a clip 74554 positioned in the end effector of theclip applier. Other embodiments are envisioned where more than oneinternal drive extends through the opening 74558, for example. The clips74554 are the same size; however, in at least one alternativeembodiment, the clips 74554 positioned at each storage location 74556are different sizes, for example. Further, in at least one alternativeembodiment, the clip size can vary between storage locations 74556, forexample. The clip applier shaft 74552 comprises a loading slot 74559configured to receive a clip 74554 when one of the storage locations74556 is aligned with the loading slot 74559. In at least oneembodiment, biasing members 74557 are configured to bias the clips 74554from the clip magazine 74550 into the loading slot 74559.

FIG. 95B depicts a clip magazine 74560 in accordance with at least oneembodiment. The clip magazine 74560 is configured to attach to and/orfit inside a clip applier shaft 74562 and is rotatable relative to theclip applier shaft 74562. The clip magazine 74560 comprises a pluralityof clips 74564 arranged in stacks and stored in the clip magazine 74560at storage locations 74566 that are radially spaced approximately 120degrees apart. The storage locations 74566 are angled to offset theedges of the clips 74564 and each storage location 74566 stores multipleclips 74564. An opening 74568 in the clip magazine 74560 allows aninternal drive of a clip applier to pass through the clip magazine74560. The internal drive can advance a clip 74564 out of the clipmagazine 74560 into an end effector of the clip applier and/or crimp aclip 74564 positioned in the end effector. Other embodiments areenvisioned where more than one internal drive extends through theopening 74568. The clips 74564 are the same size; however, in at leastone alternative embodiment, the clips 74564 positioned at each storagelocation 74566 are different sizes. In at least one alternativeembodiment, the clip size can vary between storage locations 74566, forexample. The clip applier shaft 74562 comprises a loading slot 74569configured to receive a clip 74564 when one of the storage locations74566 is aligned with the loading slot 74569. Biasing members 74567 areconfigured to bias the clips 74564 from the clip magazine 74560 into theloading slot 74569.

FIG. 95C depicts a clip magazine 74570 in accordance with at least oneembodiment. The clip magazine 74570 is configured to attach to and/orfit inside a clip applier shaft 74572 and is rotatable relative to theclip applier shaft 74572 about a magazine axis MA. The clip appliershaft 74572 defines a shaft axis SA. Further, the clip magazine 74570comprises a plurality of clips 74574 arranged in stacks and stored inthe clip magazine 74570 at storage locations 74576 that are radiallyspaced approximately 120 degrees apart. The storage locations 74576 aresized to keep the edges of the clips 74574 aligned and each storagelocation 74576 stores multiple clips 74574. The magazine axis MA isoffset from the shaft axis SA; thus, the diameter of the clip magazine74570 is reduced (as compared to the clip magazine 74550) to provideample storage for the clips 74574. Therefore, in at least oneembodiment, the storage locations 74576 are closer together than storagelocations 74556 of clip magazine 74550. The clip magazine 74570 works inconjunction with external drivers configured to advance the clips 74574out of the clip magazine 74570 and/or crimp a clip 74574 positioned inan end effector of a clip applier. In at least one embodiment, the clips74574 positioned at each storage location 74576 are different sizes. Inat least one alternative embodiment, the clip size can vary betweenstorage locations 74576. The clip applier shaft 74572 comprises aloading slot 74579 configured to receive a clip 74574 when one of thestorage locations 74576 is aligned with the loading slot 74579. Biasingmembers 74577 are configured to bias the clips 74574 from the clipmagazine 74570 into the loading slot 74579.

FIG. 95D depicts a clip magazine 74580 in accordance with at least oneembodiment. The clip magazine 74580 is configured to attach to and/orfit inside a clip applier shaft 74582 and is rotatable relative to theclip applier shaft 74582 about a magazine axis MA. The clip appliershaft 74852 defines a shaft axis SA. The clip magazine 74580 comprises aplurality of clips 74584 arranged in stacks and stored in the clipmagazine 74580 at storage locations 74586 that are radially spacedapproximately 120 degrees apart. The storage locations 74586 are sizedto keep the edges of the clips 74584 aligned and each storage location74586 stores multiple clips 74584. The magazine axis MA is offset fromthe shaft axis SA; thus, the diameter of the clip magazine 74580 isreduced (as compared to the clip magazine 74550) to provide amplestorage for the clips 74574. Therefore, in at least one embodiment, thestorage locations 74586 are closer together than storage locations 74556of clip magazine 74550, for example. The clip magazine 74580 works inconjunction with an external drive configured to advance a clip 74584out of the clip magazine 74580. Further, the clip magazine 74580 isconfigured to protrude through an opening 74589 in the clip appliershaft 74582 which provides additional space for the clip magazine 74580relative to the clip applier shaft 74582. In at least one embodiment,the clips 74584 positioned at each storage location 74586 are differentsizes. In at least one alternative embodiment, the clip size can varybetween storage locations 74586. The clip applier shaft 74582 comprisesa loading slot 74581 configured to receive a clip 74584 when one of thestorage locations 74586 is aligned with the loading slot 74581. Biasingmembers 74587 are configured to bias the clips 74584 from the clipmagazine 74580 into the loading slot 74581.

FIG. 95E depicts a clip magazine 74590 in accordance with at least oneembodiment. The clip magazine 74590 is configured to attach to and/orfit inside a clip applier shaft 74592 and is rotatable relative to theclip applier shaft 74592. The clip magazine 74590 comprises a pluralityof clips 74594 arranged in stacks and stored in the clip magazine 74590at storage locations 74596 that are radially spaced approximately 90degrees apart. The storage locations 74596 are sized to keep the edgesof the clips 74594 aligned and can store multiple clips in eachlocation, for example. The clips 74594 are the same size; however, in atleast one alternative embodiment, the clips 74594 positioned at eachstorage location 74596 are different sizes. In at least one alternativeembodiment, the clip size can vary between storage locations 74596. Theclip magazine 74590 is rotated using a gear and tooth arrangement 74591.More specifically, the clip magazine 74590 further comprises acircumferential rack of teeth 74593 that extends between the storagelocations 74596. The circumferential rack of teeth 74593 is operablyengaged with a rotatable drive shaft 74599 of a clip applier. Therotatable drive shaft 74599 comprises a gear 74598 fixed thereto whichis engaged with the circumferential rack of teeth 74593. Thus, as therotatable drive shaft 74599 rotates, the clip magazine 74590 rotatesrelative to the clip applier shaft 74592. The clip applier shaft 74592comprises a loading slot 74595 configured to receive a clip 74594 whenone of the storage locations 74596 is aligned with the loading slot74595. Biasing members 74597 are configured to bias the clips 74594 fromthe clip magazine 74590 into the loading slot 74595.

FIG. 96 depicts a clip magazine 74600 in accordance with at least oneembodiment. The clip magazine 74600 is configured for use with a clipapplier and the clip magazine 74600 is configured to store a pluralityof clips 74610. The clips 74610 are arranged in the clip magazine 74600in a clip stack and are held in the clip magazine 74600 by a clipchannel 74620 that is angled laterally relative to the radius of theclip magazine 74600. The clip channel 74620 partially mimics the shapeof the clips 74610 in the clip stack in order to hold the clips 74610into the clip magazine 74600. More specifically, the clip channel 74620provides space for the clips 74610 to slide relative to the clip channel74620 at discrete locations and at other discrete locations the clipchannel 74620 releasably holds the clips 74610 in place. For example,the clip channel 74620 can comprises discrete holding locations 74630and 74640 to hold the clips 74610 in place. The discrete holdinglocations 74630, 74640 provide for a tighter fit between the clips 74610and the clip channel 74620 as compared to the rest of the clip channel74620. The discrete holding locations 74630, 74640, along with theangled clip channel 74620, maintain the clips 74610 in the clip magazine74600 until the clips 74610 are ejected.

FIGS. 97A and 97B depict a clip magazine 74700 in accordance with atleast one embodiment. The clip magazine 74700 is configured to beattached to and/or fit inside a shaft 74720 of a clip applier, forexample. The shaft 74720 defines a shaft axis SA. The clip magazine74700 comprises a carriage 74710 comprising a plurality of clip holders74712 configured to store a plurality of clips 74714. The clip holders74712 extend from the driven portion of the carriage 74710 such that theplurality of clips 74714 are positioned distal to the carriage 74710.The clip magazine 74700 is configured to rotate relative to the shaft74720 about the shaft axis SA between a plurality of clip firingpositions (FIG. 97A) and a plurality of clip loading positions (FIG.100). The clip magazine 74700 is rotatable via a rotary input 74726which is operably responsive to a motor of a clip applier. As the clipmagazine 74700 is rotated, the clips 74714 are configured to be biasedinto a clip track 74716 of the shaft 74720 when the clip magazine 74700is in a loading position, as illustrated in FIG. 100. A clip 74714positioned in the clip track 74716 is configured to be advanced into anend effector of the clip applier by a feeder shoe 74724 when the clipmagazine 74700 is in a firing position, as illustrated in FIG. 97A.Other embodiments are envisioned where the clip track 74716 is part ofthe clip magazine 74700 and is aligned with another clip track in theshaft 74720 to facilitate the stripping and advancement of clips 74714from the clip magazine 74700, for example.

Further to the above, each clip holder 74712 stores two clips 74714.Other embodiments are envisioned where each clip holder 74712 stores oneclip or more than two clips 74714. Each clip holder 74712 comprisesbiasing members 74713 (see FIG. 101) configured to bias the clips 74714away from the shaft axis SA. The clip track 74716 is configured toreceive a clip 74714 when one of the clips 74714 is biased into the cliptrack 74716 (e.g., when the clip magazine 74700 is in a loadingposition, for example). Further, when the clip magazine 74700 isinitially loaded into the clip applier one of the clips 74714 canalready be loaded in the clip track 74716 as illustrated in FIG. 97A.The clip magazine 74700 further comprises a lockout, or lockout clip74718, configured to prevent further rotation of the clip magazine 74700after all of the clips 74714 have been spent. The lockout clip 74718extends proximally further than the clips 74714, as illustrated in FIG.97B, to allow the lockout clip 74718 to interfere with the carriage74710 when the clip magazine 74700 is empty. Operation of the clipmagazine 74700 is described in greater detail below.

In the orientation depicted in FIG. 97A, the clip magazine 74700 is in afiring position. After initially loading the clip magazine 74700 intothe clip applier, a clip 74714 is already loaded into the clip track74716 by the biasing members 74713, as discussed above. The initiallyloaded clip 74714 can be advanced into the end effector of the clipapplier by a feeder shoe 74724 of the clip applier. The feeder shoe74724 extends on a side of the carriage 74710 to engage the clip 74714without interfering with the clip magazine 74700. Once the feeder shoe74724 is retracted, the next clip 74714 is rotated into place asdescribed in greater detail below.

Referring now to FIG. 98, after the initial clip 74714 is advanced bythe feeder shoe 74724 and the feeder shoe 74724 is retracted, the clipmagazine 74700 is rotated toward a loading position (see FIG. 100). Asthe clip magazine 74700 rotates toward a loading position, the leadingedge of the next clip 74714 drops into a recessed portion 74719 of theclip track 74716 (see FIG. 98). As the clip magazine 74700 rotatesfurther toward the loading position, the clip 74714 begins to seat inthe clip track 74716 (see FIG. 99). Referring now to FIG. 100, the clip74714 is biased completely into the clip track 74716 by the biasingmembers 74713 when the clip 74714 and the clip track 74716 arecompletely aligned. The clip 74714 is now in the loading position.Further operation of the clip magazine 74700 is discussed in greaterdetail below.

As the clip magazine 74700 rotates from the loading position depicted inFIG. 100 to another firing position, the remaining clips 74714 are heldin their respective clip holders 74712. More specifically, referring toFIG. 100, another clip 74714 is sitting on top of the clip 74714 in theclip track 74716 when the clip magazine 74700 is in the loadingposition. This clip 74714 will continue to rotate with the carriage74710 when the carriage 74710 is rotated as there is no room for theclip 74714 to move toward the clip track 74716 because the clip track74716 is already occupied by a clip 74714. Once the clip magazine 74700is rotated into the firing position, the clip 74714 positioned in theclip track 74716 is advanced into the end effector by the feeder shoe74724, as discussed above. As the clip magazine 74700 is rotated towardanother loading position, another clip 74714 is stripped (i.e., biasedinto the clip track 74716), as discussed above. This sequence continuesuntil all of the clips 74714 are stripped from the clip magazine 74700and advanced into the end effector. The outer clips 74714 (i.e., clips2, 3, and 4) are stripped from the clip magazine 74700 first based onthe arrangement described above. Once all of the outer clips 74714 arestripped the inner clips 74714 (i.e., clips 5, 6, and the lockout clip74718) can be stripped from the clip magazine 74700. The lockout clip74718 of the clip magazine 74700 is described in greater detail below.

Referring now to FIG. 101, after all of the clips 74714 have beenstripped from the clip magazine 74700, the lockout clip 74718 is biasedinto the clip track 74716 when the clip magazine 74700 is rotated into afinal loading position. As discussed above, the lockout clip 74718extends further proximally toward the carriage 74710 than the clips74714 (see FIG. 97B). Therefore, when the lockout clip 74718 ispositioned in the clip track 74716 the lockout clip 74718 will interferewith the carriage 74710 as the clip magazine 74700 rotates from theloading position to the firing position. More specifically, the carriage74710 of the clip magazine 74700 will engage the top of the lockout clip74718 which prevents further rotation of the clip magazine 74700. Thebiasing members 74713 push the lockout clip 74718 into the clip track74716 and hold the lockout clip 74718 in place. Alternatively, thebiasing members 74713 in the last clip holder 74712 location can beconfigured to extend into the clip track 74716 to prevent furtherrotation of the clip magazine 74700 after all of the clips have beenspent.

As a means to minimize rotational binding of the clips 74714 as the clipmagazine 74700 rotates, the clip magazine 74700 can vary the amount offorce the biasing members 74713 apply to the clips 74714 depending onthe orientation of the clip magazine 74700, for example. In at least oneembodiment, the clip magazine 74700 can decrease the amount of force thebiasing members 74713 apply to the clips 74714 when the clip magazine74700 is in a firing position. Alternatively, the clip magazine 74700can increase the amount of force the biasing members 74713 apply to theclips 74714 in order to encourage the clip 74714 above the clip track74716 into the clip track 74716 when the clip magazine 74700 is in aloading position. Other embodiments are envisioned where the clipmagazine 74700 can relieve the spring bias of the biasing members 74713just before a clip 74714 is aligned with the clip track 74716 (see FIGS.98 and 99) and increase the spring bias when a clip 7471 is aligned withthe clip track 74716 (see FIG. 100) in order to only encourage the clip74714 to eject from the clip holder 74712 when the clip 74714 and theclip track 74716 are aligned. To reduce the spring bias in the nonloading positions (i.e. the firing positions), the inside diameter 74722of the clip magazine 74700 can be eccentric with respect to the travelpath of the carriage 74710. In such instances, the inside diameter 74722of the clip magazine 74700 can be shaped such that the biasing members74713 are compressed when the clip magazine 74700 is in a loadingposition providing more force to the clips 74714. Further, the insidediameter 74722 can provided room for the biasing members 74713 to extendwhen the clip magazine 74700 is in a firing position and/or moving froma firing position to a loading position to provide less force to thedips 74714.

Further to the above, as another means to minimize rotational binding ofthe clips 74714 as the clip magazine 74700 rotates, the inside diameter74722 of the clip magazine 74700 can be polished to reduce the frictionbetween the carriage 74710 and the inside diameter 74722. Otherembodiments are envisioned where the inside diameter 74722 is onlypolished in certain areas to reduce rotational friction when thecarriage 74710 is rotated through certain radial positions, for example.In such instances, the high friction forces can hold the clip magazine74700 in position when firing.

FIGS. 102-106 depict a clip applier 74800 in accordance with at leastone embodiment. The clip applier 74800 comprises a clip magazine 74810comprising a plurality of clips, a rotary input 74820, a shaft 74830extending from a housing, a feeder shoe 74840, and a crimping drive74850. The shaft 74830 defines a shaft axis SA and the clip magazine74810 is translatable along and rotatable about the shaft axis SA. Theplurality of clips comprise a first set of clips 74806 stored on a firstside 74812 of the clip magazine 74810, a second set of clips 74807stored on a second side 74814 of the clip magazine 74810, and a thirdset of clips 74808 stored on a third side 74816 of the clip magazine74810. The first side 74812, the second side 74814, and the third side74816 are positioned approximately 120 degrees apart about the shaftaxis SA. Each of the first, second, and third sets of clips 74806,74807, 74808 are biased radially outward relative to the clip magazine74810 by biasing members 74809 (see FIG. 104). The first, second, andthird sets of clips 74806, 74807, 74808 are stored in clip slots 74804of the clip magazine 74810. The rotary input 74820 is configured torotate in response to rotary motions generated by a motor positioned inthe housing of the clip applier 74800. The rotary input 74820 isthreadably engaged with the clip magazine 74810. Operation of the clipapplier 74800 is discussed in greater detail below.

To strip the first set of clips 74806 from the clip magazine 74810, theclip magazine 74810 is translated distally by the rotary input 74820until the first set of clips 74806 are aligned with a loading slot 74832in the bottom of the shaft 74830 of the clip applier 74800. The firstset of clips 74806 comprises a first clip 74806 a and a second clip74806 b (see FIG. 106). The clip magazine 74810 is rotatably constrainedwithin the shaft 74830 of the clip applier 74800 by the first set ofclips 74806 and the biasing members 74809 such that when the rotaryinput 74820 is rotated in direction D1, the clip magazine 74810 istranslated between a proximal position (FIG. 102) and a distal position(FIG. 103).

The clip magazine 74810 can then be retracted from the distal position(FIG. 103) to the proximal position (FIG. 102) to strip the first clip74806 a from the clip magazine 74810 by rotating the rotary input 74820is an opposite direction D2. Notably, the second clip 74806 b of thefirst set of clips 74806 is positioned on top of the first clip 74806 ain the loading slot 74832 when the clip magazine 74810 is in the distalposition, and therefore, the clip magazine 74810 is still rotatablyconstrained via the biasing members 74809. Thus, the clip magazine 74810will translate proximally in response to a rotation of the rotary input74820 in direction D2 (FIG. 102). Once the clip magazine 74810 isretracted to the proximal position, the first clip 74806 a in theloading slot 74832 can be advanced into an end effector of the clipapplier 74800 by the feeder shoe 74840. The clip magazine 74810 can thenbe translated from the proximal position to the distal position to placethe second clip 74806 b into the loading slot 74832. At this point, theclip magazine 74810 is still rotatably constrained by the biasingmembers 74809 which are still engaged with the second clip 74806 b as itsits in the loading slot 74832. As such, rotation of the rotary input74820 will translate the clip magazine 74810 proximally when the rotaryinput 74820 is rotated in the second direction D2. Further, when thebiasing members 74809 are retracted proximally beyond the loading slot74832, the biasing members 74809 still apply a force to the shaft 74830of the clip applier 74800 and thus continue to rotatably constrain theclip magazine 74810. Once the clip magazine 74810 is in the proximalposition, the second clip 74860 b in the loading slot 74832 can beadvanced into the end effector of the clip applier 74800 by the feedershoe 74840. At this point, the clip magazine 74810 no longer has clipsremaining on the first side 74812 of the clip magazine 74810. The clipmagazine 74810 can then be translated from the proximal position (FIG.102) to the distal position (FIG. 103) owing to the biasing members74809 rotatably constraining the clip magazine 74810 against the shaft74830, as discussed above. Once in the distal position (FIG. 103), theclip magazine 74810 will no longer be rotatably constrained as thebiasing members 74809 no longer have a clip in the loading slot 74832 topress against; and, thus, the biasing members 74809 no longer rotatablyconstrain the clip magazine 74810. More specifically, the biasingmembers 74809 only extend downward far enough to engage the shaft 74830of the clip applier 74800 and do not extend into the loading slot 74832.Thus, if a clip is not positioned in the loading slot 74832, the clipmagazine 74810 will rotate in response to the rotation of the rotaryinput 74820. At this point, rotation of the rotary input 74820 rotatesthe clip magazine 74810.

Further to the above, when the loading slot 74832 is empty and therotary input 74820 is rotated, the clip magazine 74810 will rotate untilthe second set of clips 74807 align with, and are biased toward, theloading slot 74832. The first clip of the second set of clips 74807 willoccupy the loading slot 74832 and thus the clip magazine 74810 willagain be rotatably constrained as discussed above. The clip magazine74810 can now be translated between the distal position (FIG. 103) andthe proximal position (FIG. 102) to strip the first clip and the secondclip of the second set of clips 74807 from the clip magazine 74810. Oncethe first and second clip of the second set of clips 74807 are strippedand advanced, the clip magazine 74810 can be rotated to align the thirdset of clips 74808 with the loading slot 74832. The third set of clips74808 can follow the same ejection and advancement sequence as the firstset of clips 74806 and the second set of clips 74807. Other embodimentsare envisioned where the clip magazine 74810 comprises more or less thanthree sides comprising clips, for example.

As the clip magazine 74810 translates from the proximal position (seeFIG. 102) to the distal position (see FIG. 103), further to the above,the clip magazine 74810 engages a distal stop 74860 which extendsdownward from the shaft 74830 of the clip applier 74800. The distal stop74860 prevents further distal translation of the clip magazine 74810 andproperly aligns the clip magazine 74810 with the loading slot 74832.Further, the rotary input 74820 comprises a proximal stop 74862 whichprevents further proximal translation of the clip magazine 74810. Asmentioned above, the rotary input 74820 is threadably engaged with theclip magazine 74810. Other embodiments are envisioned with differentrotary input to clip magazine connections, as discussed in greaterdetail below.

FIG. 107 depicts a rotary input 74920 and a clip magazine 74910 inaccordance with at least one embodiment. The rotary input 74920 and clipmagazine 74910 are similar to the rotary input 74820 and clip magazine74810 of the clip applier 74800 in many respects (see FIGS. 102-106).For example, the rotary input 74920 is threadably engaged with the clipmagazine 74910 and the rotary input 74820 is configured to advance,retract, and rotate the clip magazine 74910. The rotary input 74920comprises protrusions 74922 extending from a distal end of the rotaryinput 74920. The protrusions 74922 are engaged with an internal thread74912 of the clip magazine 74910. When the rotary input 74920 isrotated, and the clip magazine 74910 is rotatably constrained, the clipmagazine 74910 will translate. In such instances, the protrusions 74922of the rotary input 74920 engage the internal threads 74912 of the clipmagazine 74910 to linearly advance and retract the clip magazine 74910.The rotary input 74920 is configured to rotate in a first direction totranslate the clip magazine 74910 distally and, correspondingly, asecond direction, opposite the first direction, to translate the clipmagazine 74910 proximally. In use, the rotary input 74920 is rotatedclock-wise and counter clock-wise to achieve the desired range of motionfor the clip magazine 74910, such as translating the clip magazine 74910back and forth between a proximal position and a distal position, forexample.

FIGS. 108 and 109 depict a rotary input 74940 and a clip magazine 74930in accordance with at least one embodiment. The rotary input 74940 andclip magazine 74930 are similar to the rotary input 74820 and clipmagazine 74810 of the clip applier 74800 in many respects (see FIGS.102-106). For example, the rotary input 74940 is threadably engaged withthe clip magazine 74930 and the rotary input 74940 is configured toadvance, retract, and rotate the clip magazine 74930. The clip magazine74930 comprises a plurality of clips 74934 and a biasing member 74936which acts to bias the clips 74934 out of the clip magazine 74930. Therotary input 74940 comprises external threads 74942 which are engagedwith a collar 74932 in the clip magazine 74930. The collar 74932 engagesthe external threads 74942 at the base of the external threads 74942 andis configured to ride along the external threads 74942 of the rotaryinput 74940 to translate the clip magazine 74930 when the rotary input74940 is rotated. The rotary input 74940 is a multi-direction rotarydriver for the clip magazine 74930 that advances and retracts the clipmagazine 74930 to strip clips from the clip magazine 74930. The rotaryinput 74940 is configured to rotate in a first direction to advance theclip magazine 74930 distally and, correspondingly, in a seconddirection, opposite the first direction, to advance the clip magazine74930 proximally. In use, the rotary input 74940 is rotated clock-wiseand counter clock-wise to achieve the desired range of motion for theclip magazine 74930, such as translating the clip magazine 74930 backand forth between a proximal position and a distal position, forexample.

FIG. 110 depicts a rotary input 74960 and a clip magazine 74950 inaccordance with at least one embodiment. The rotary input 74960 and clipmagazine 74950 are similar to the rotary input 74820 and clip magazine74810 of the clip applier 74800 in many respects (see FIGS. 102-106).For example, the rotary input 74960 is threadably engaged with the clipmagazine 74950 and is configured to advance, retract, and rotate theclip magazine 74950. The rotary input 74960 comprises protrusions 74962extending from the rotary input. The protrusions 74962 are engaged withan internal thread 74952 of the clip magazine 74950. The internal thread74952 is a single-direction thread; thus, when the rotary input 74960 isrotated and the clip magazine 74950 is rotatably constrained, the clipmagazine 74950 translates between a proximal position and a distalposition. Once the clip magazine 74950 has reached the distal position,the protrusions 74962 move through a distal end 74954 of the internalthread 74952 which switches the direction the clip magazine 74950 istranslated while the rotary input 74960 rotates in the same direction.The internal thread 74952 comprises a left-hand thread portion and aright-hand thread portion which are connected at their distal ends suchthat the left-hand threaded portion and the right-hand threaded portioncomprise one continuous thread groove. Therefore, the rotary input 74960need only be rotated in one direction to achieve the desired range ofmotion for the clip magazine 74950, i.e., translating the clip magazine74950 back and forth between the proximal position and the distalposition.

FIG. 111 depicts a rotary input 74980 and a clip magazine 74970 inaccordance with at least one embodiment. The rotary input 74980 and clipmagazine 74970 are similar to the rotary input 74820 and clip magazine74810 in many respects. For example, the rotary input 74980 isthreadably engaged with the clip magazine 74970 and the rotary input74880 is configured to advance, retract, and rotate the clip magazine74970. The rotary input 74980 comprises a thread groove 74982 defined onthe outside of the rotary input 74980 which is engaged with a collar74972 in the clip magazine 74970. The collar 74972 engages the threadgroove 74982 at the base of the thread groove 74982. The thread groove74982 is a single-direction thread, thus, when the rotary input 74980 isrotated and the clip magazine 74970 is rotatably constrained, the clipmagazine 74970 translates back and forth between a proximal position anda distal position. Once the clip magazine 74970 has reached the distalposition, the collar 74972 will move through a distal end 74984 of thethread groove 74982 which switches the direction the clip magazine 74970is translated while the rotary input 74980 rotates in the samedirection. The thread groove 74982 comprises a left-hand thread portionand a right-hand thread portion which are connected at their distal endssuch that the left-hand threaded portion and the right-hand threadedportion comprise one continuous thread groove. Therefore, the rotaryinput 74980 need only be rotated in one direction to achieve the desiredrange of motion for the clip magazine 74970, i.e., translating the clipmagazine 74970 back and forth between the proximal position and thedistal position.

FIG. 112 depicts a rotary input 74990 and a clip magazine 74995 inaccordance with at least one embodiment. The rotary input 74990 and theclip magazine 74995 are similar to the rotary input 74820 and clipmagazine 74810 of the clip applier 74800 in many respects (see FIGS.102-106). For example, the rotary input 74990 is threadably engaged withthe clip magazine 74995 and the rotary input 74980 and the clip magazine74995 are configured to advance, retract, and rotate the clip magazine74995. The clip magazine 74995 comprises an upper portion 74995 a and alower portion 74995 b which are assembled together using alignment pins74999 and a coupling collar 74997. The clip magazine 74995 furthercomprises a cutout region 74996 configured to receive the couplingcollar 74997 when the upper portion 74995 a and the lower portion 74995b are positioned together. The coupling collar 74997 and alignment pins74999 are configured to hold the upper portion 74995 a and the lowerportion 74995 b together.

Further to the above, the clip magazine 74995 comprises an internalthread 74991 that can be molded and/or machined into the inside diameterof the clip magazine 74995. The upper portion 74995 a and the lowerportion 74995 b can be assembled around the rotary input 74990 such thatprotrusions 74992 extending from the rotary input 74990 are engaged withthe internal thread 74991. The internal threads 74991 can be moldedand/or machined into any of the internal threads types described herein.The rotary input 74990 can be a single direction driver and/or a multidirection driver, as described herein, depending on the internal threadsutilized. Further, a crimping drive 74993 can be placed through anopening in the rotary input 74990 such that the crimping drive 74993 andthe rotary input 74990 are co-axial. The crimping drive 74993 isconfigured to actuate jaws of an end effector of the clip applier tocrimp a clip positioned between the jaws.

A cross-sectional view of the clip magazine 74995 located inside a shaft74994 of a clip applier, for example, is depicted in FIG. 113. In orderto achieve the clam-shell construction described above (e.g., piecingtogether the upper portion 74995 a and the lower portion 74995 b of theclip magazine 74995) the clip magazine 74995 can be split so that onlyone clip storage location 74998 is cut in half. This allows for easyassembly and alignment of the upper portion 74995 a and the lowerportion 74995 b.

FIG. 114 depicts a clip applier 76000 in accordance with at least oneembodiment. The clip applier 76000 comprises a rotary input 76022, amagazine driver 76020 extending from the rotary input 76022, a clipmagazine 76010, a firing drive 76030, and a biasing member 76040. Therotary input 76022 comprises a flexible rotary drive to flex and/or bendaround an articulation joint of the clip applier. The magazine driver76020 comprises a first cam surface 76024 comprising a notch 76026 atthe distal end thereof. The clip magazine 76010 comprises a second camsurface 76014 comprising a protrusion 76016 extending from the proximalend thereof. The clip applier 76000 is shown in an exploded view in FIG.114, with the clip magazine 76010 separated from the magazine driver76020 in order to show the biasing member 76040.

Further to the above, the clip magazine 76010 is configured to translatebetween a proximal position (FIG. 115A) and distal position (FIG. 115B)relative to the magazine driver 76020 as the magazine driver 76020rotates. The biasing member 76040 is configured to bias the clipmagazine 76010 toward the proximal position and against the magazinedriver 76020. The first cam surface 76024 and the second cam surface76014 comprise complementary shapes and, when the clip magazine 76010 isin the proximal position (FIG. 115A), the first cam surface 76024 andthe second cam surface 76014 are aligned. The second cam surface 76014comprises a raised shoulder and the first cam surface 76024 is supportedby a body 76003 of the clip magazine 76010 when the clip magazine 76010and magazine driver 76020 are engaged. The clip magazine 76010 furthercomprises a first clip storage location 76001, a second clip storagelocation 76002, and a third clip storage location configured to storeclips 76004 for clipping tissue. In the embodiment illustrated in FIG.114, there are three clip storage locations, each of the clip storagelocations are configured to store two clips 76004. Other embodiments areenvisioned with more than or less than three clip storage locations witheach clip storage location storing more or less than two clips 76004,for example. The rotary input 76022 is configured to rotate the magazinedriver 76020 to both translate and rotate the clip magazine 76010 asdescribed in greater detail below.

Referring now to FIG. 115A, the clip magazine 76010 is in its proximalposition relative to the magazine driver 76020. As the rotary input76022 is rotated in a first direction D₁, the first cam surface 76024 ofthe magazine driver 76020 engages the second cam surface 76014 of theclip magazine 76010 to translate the clip magazine 76010 to its distalposition (FIG. 115B). In the distal position, the first clip storagelocation 76001 is located over a loading slot of the clip applier,similar to loading slot 74832 described in relation to clip applier74800, for example. In at least one embodiment, a clip 76004 is ejectedout of the first clip storage location 76001 by the biasing members76006 into the loading slot when the first clip storage location 76001is aligned with the loading slot. The rotary input 76022 is then rotatedin a second direction D₂ to move the magazine driver 76020 from thedistal position to the proximal position to strip the clip 76004 fromthe clip magazine 76010. Notably, the biasing member 76040 pulls theclip magazine 76010 toward the magazine driver 76020 such that thesecond cam surface 76014 and the first cam surface 76024 are continuallyengaged as the magazine driver 76020 is rotated in the second directionD₂. After the first clip in the first clip storage location 76001 hasbeen stripped, the clip magazine 76010 can be advanced from the proximalposition to the distal position, as discussed above, to align the secondclip in the first clip storage location 76001 with the loading slot. Tostrip the second clip, the clip magazine 76010 is rotated to align thesecond clip storage location 76002 with the loading slot as discussed ingreater detail below.

With the second clip of the first clip storage location 76001 located inthe loading slot and the clip magazine 76010 positioned in its distalposition, a further rotation of the magazine driver 76020 in the firstdirection D₁ will rotate the clip magazine 76010 to strip the secondclip from the first clip storage location 76001. In such instances, therotary input 76022 will rotate the magazine driver 76020 to engage thenotch 76026 of the magazine driver 76020 with the protrusion 76016 ofthe clip magazine 76010. Once the notch 76026 and the protrusion 76016are engaged, the clip magazine 76010 will rotate with the magazinedriver 76020 as the rotary input 76022 rotates in direction D₁. The clipmagazine 76010 rotates 120 degrees in the first direction D₁ to alignthe second clip storage location 76002 with the loading slot asillustrated in FIG. 115C. The first clip 76004 in the second clipstorage location 76002 is stripped from the clip magazine 76010 bytranslating the clip magazine 76010 from its distal position to itsproximal position via the magazine driver 76020 and biasing member76040, as discussed above. After the first clip 76004 in the second clipstorage location 76002 has been stripped, the clip magazine 76010 can berotated by the magazine driver 76020 another 120 degrees in the firstdirection D₁ to strip the second clip in the second clip storagelocation 76002 and align the third clip storage location with theloading slot. The first clip in the third clip storage location can bestripped via the retraction of the clip magazine 76010 between itsdistal position and its proximal position, as discussed above. Thesecond clip in the third clip storage location can also be stripped viathe retraction of the clip magazine 76010 between its distal positionand its proximal position, as discussed above. Further, the second clipin the third clip storage location can also be stripped via a rotationof the clip magazine 76010 in the first direction D₁ when the clipmagazine is in its distal position, as discussed above.

Further to the above, alternative embodiments are envisioned where theclip magazine 76010 comprises a notch at the proximal end of the secondcam surface 76014 and the magazine driver 76020 comprises a protrusionat the distal end of the first cam surface 76024. The notch andprotrusion can perform the same functions as the notch 76026 andprotrusion 76016 discussed above (i.e., engaging the magazine driver76020 with the clip magazine 76010 in its distal position to rotate theclip magazine 76010, for example).

FIG. 116 is a graphical depiction of the rotary position of the magazinedriver 76020 of the clip applier 76000 versus time. When the magazinedriver 76020 is at position 76110, the clip magazine 76010 is in itsproximal position illustrated in FIG. 115A. When the magazine driver76020 is rotated to 90 degrees from zero, the clip magazine 76010 ismoved to its distal position depicted in FIG. 115B and the first clip76004 from the first clip storage location 76001 is biased into theloading slot. The magazine driver 76020 can then be rotated back to 0degrees at position 76120 to strip the first clip 76004 from the firstclip storage location 76001, as discussed above. The magazine driver76020 can then be rotated 90 degrees from zero to place the second clipfrom the first clip storage location 76001 into the loading slot atposition 76130. The second clip from the first clip storage location76001 is then stripped when the magazine driver 76020 is rotated to 210degrees from zero at position 76140. The second clip storage location76002 is now aligned with the loading slot, and the first clip from thesecond clip storage location 76002 is biased into the loading slot atposition 76140. The first clip from the second clip storage location76002 is stripped when the magazine driver 76020 is rotated back to 90degrees from zero at position 76150. As the magazine driver 76020rotates to 210 degrees from zero the second clip from the second clipstorage location 76002 is aligned with, and biased into, the loadingslot at position 76160. The magazine driver is then rotated to 330degrees from zero to strip the second clip from the second clip storagelocation 76002 and to align the first clip from the third clip storagelocation with the loading slot at position 76170. The first clip fromthe third clip storage location can be stripped when the magazine driver76020 rotates back to 210 degrees from zero at position 76180. Thesecond clip in the third clip storage location is then aligned with, andbiased into, the loading slot when the magazine driver 76020 is rotatedto 330 degrees from zero. The second clip in the third clip storagelocation can be stripped from the clip magazine 70610 either by rotatingmagazine driver 76020 back 90 degrees to 210 degrees from zero atposition 76194 to retract the clip magazine 70610 to the proximalposition, or by rotating the magazine driver 76020 an additional 120degrees to 90 degrees from zero at position 76192 to rotate the clipmagazine 70610 and strip the clip.

FIG. 117 depicts a clip applier 76200 in accordance with at least oneembodiment. The clip applier 76200 comprises a distal head 76220extending from an elongate shaft, a clip magazine 76210, an end effector76230 extending through and from the distal head 76220, a clip carriage76260, and a clip former 76242. The distal head 76220 is articulatablerelative to the elongate shaft. The end effector 76230 comprises a pairof opposing jaws which are movable between an open position and closedposition by a jaw cam 76232, as discussed herein. The jaw cam 76232 isoperably engaged with a jaw cam driver 76250. As the jaw cam driver76250 is rotated, the jaw cam 76232 is translated between a proximalposition and a distal position to move the jaws of the end effector72630 between the open position and the closed position. The jaw camdriver 76250 is rotatable in response to rotary motions generated by amotor in the housing of the clip applier 76200.

Further to the above, the jaw cam driver 76250 passes through an openingin the clip magazine 76210 and through an opening in a magazine driver76202 extending proximally from the clip magazine 76210. The magazinedriver 76202 is configured to rotate the clip magazine 76210 in responseto rotary motions generated by the motor in the housing of the clipapplier 76200. The magazine driver 76202 and the jaw cam driver 76250are configured to rotate about the same axis (see FIG. 121). The clipmagazine 76210 comprises a plurality of clips 76204 stored in aplurality of clip storage locations. Each clip storage locationcomprises a pair of clips 76204 stacked on top of one another, forexample. The clips 76204 can be biased out of the clip storage locationsby a biasing member, such as a leaf spring, for example, into a loadingslot 76262 of the clip carriage 76260 as described in further detailbelow. Other embodiments are envisioned where the clip magazine 76210stores one clip or more than two clips 76204 in each clip storagelocation.

The clip magazine 76210 is configured to rotate between a plurality ofstorage positions and a plurality of ejection positions. In the storagepositions of the clip magazine 76210, the clips 76204 cannot be ejectedfrom the clip magazine 76010. In the ejection positions of the clipmagazine 76210, one of the clip storage locations is aligned with theloading slot 76262 of the clip carriage 76260, and one of the clips76204 is biased from the clip magazine 76210 into the loading slot76262. After a clip 76204 is positioned in the loading slot 76262, asillustrated in FIG. 118A, the clip 76204 can either be advanced distallyto a staging position 76224 or retracted proximally to a formingposition 76228 by the clip carriage 76260 as described in greater detailbelow.

The clip carriage 76260 is configured to translate proximally anddistally in response to the rotation of a carriage driver 76264. Thecarriage driver 76264 is configured to rotate in response to rotarymotions generated by the motor in the housing of the clip applier 76200.To advance a clip 76204 into the staging position 76224, the carriagedriver 76264 is rotated in a first direction. After the clip carriage76260 advances the clip 76204 to the staging position 76224 (see FIG.118B), the clip carriage 76260 can be retracted proximally as a biasingmember, or leaf spring 76226, engages the back side of the clip 76204 tokeep the clip 76204 in the staging position 76224 (see FIG. 118C). Theclip carriage 76260 is retracted via the carriage driver 76264 as thecarriage driver 76264 rotates in a second direction opposite the firstdirection. After the clip 76204 is placed in the staging position 76224and the clip carriage 76260 is retracted, the clip carriage 76260 can beadvanced to engage a distal end 76266 of the clip carriage 72260 withthe clip 76204 to advance the clip 76204 into the end effector (seeFIGS. 118C and 118D).

Further to the above, after a clip 76204 is positioned in the loadingslot 76262 from the clip magazine 76210, as illustrated in FIG. 118A,the clip carriage 76260 is retracted to a forming position 76228 byrotating the carriage driver 76264 in the second direction. Once in theforming position 76228 (see FIGS. 119A and 119B), the clip former or,anvil 76242, is lowered in between opposing legs 76204 a and 76204 b(see FIGS. 120A and 120B) of the clip 76204 by an anvil driver 76240.The anvil driver 76240 is configured to translate in response to rotarymotions generated by the motor of the clip applier 76200, or anothermotor of the clip applier 76200, such that, as the anvil driver 76240 istranslated, the anvil 76242 is configured to translate closer to andaway from the loading slot 76262 of the clip carriage 76260—depending onthe direction of translation of the anvil driver 76240.

Notably, the anvil driver 76240 comprises a pair of laterally extendingpins 76244 which engage a pair of angled slots 76246 in the anvil 76242.When the anvil driver 76240 is translated distally, the anvil movestoward the loading slot 76262. When the anvil driver 76240 is translatedproximally, the anvil 76242 moves away from the loading slot 76262.Forming of the clip 76204 positioned in the loading slot 76262 isdescribed in further detail below.

After the anvil 76242 is lowered in between the legs 76204 a and 76204 bof the clip 76204, the clip carriage 76260 is advanced distally, asdiscussed above, such that the legs 76204 a and 76204 b of the clip76204 are expanded away from each other by the anvil 76242 (see FIG.120B). The clip 76204 comprises an angled portion 76206 connecting thelegs 76204 a and 76204 b of the clip 76204 which is engaged by the anvil76242 as the clip carriage 76260 is advanced such that the angledportion 76206 is deformed from a collapsed orientation (see FIG. 120A)to an expanded orientation (see FIG. 120B). After the clip 76204 hasbeen expanded, the anvil 76242 can be moved away from the loading slot76262 by the anvil driver 76240 such that the clip carriage 76260 canadvance the clip 76204 into the staging position 76224, as describedabove. Once in the staging position 76224, the clip 76204 can beadvanced into the end effector 76230 as discussed above.

Further to the above, the staging position 76224 is configured to storea single clip 76204. However, other embodiments are envisioned where thestaging position 76224 is configured to store a plurality of clips 76204in a clip stack, for example. The plurality of clips in the clip stackin the staging position 76224 can either be formed or unformed, asdiscussed above, and can be stacked in the staging position 76224 untilthey are sequentially advanced into the end effector by the clipcarriage 76260 in the manner discussed above.

As discussed above, the jaw cam driver 76250, the magazine driver 76202,the carriage driver 76264, and the anvil driver 76240 are configured torotate in response to rotary motions generated by the same motor of theclip applier 76200, or different motors of the clip applier 76200, inorder to perform specific distal head functions. The motor of the clipapplier 76200 further comprises a motor controller configured to controlthe jaw cam driver 76250, the magazine driver 76202, the carriage driver76264, and the anvil driver 76240. The jaw cam driver 76250, themagazine driver 76202, the carriage driver 76264, and the anvil driver76240 can be actuated by the motor controller to synchronize the driversand/or interrupt one or more of the drivers in order to perform moredistal head functions than there are dedicated drivers.

FIG. 122 depicts a clip applier 76300 in accordance with at least oneembodiment. The clip applier 76300 comprises an outer tube 76305extending from a housing, a clip magazine 76307 attachable to the outertube 76305, and an end effector 76309. The outer tube 76305 comprises aproximal tube portion 76380, an articulation tube portion 76350extending from the proximal tube portion 76380, and a distal tubeportion 76340 extending from the articulation tube portion 76350. Theend effector 76309 comprises a first jaw 76310 movable relative to asecond jaw 76320 between an open position and a closed position. Thesecond jaw 76320 extends from the distal tube portion 73640 and thefirst jaw 76310 is rotatable relative to the second jaw about a pivotpin 76315. The first jaw 76310 is actuatable between the open positionand the closed position via a jaw driver 76360 which is configured torotate relative to the outer tube 76305 in response to rotary motionsgenerated within the housing of the clip applier 76300. Otherembodiments are envisioned where the first jaw 76310 and the second jaw76320 are both rotatable relative to each other between an open and aclosed position, for example.

Further to the above, the clip magazine 76307 comprises a plurality ofclips removable stored therein. Each of the clips is translatable intothe end effector 76309 by a clip advancer of the clip applier 76300which is operably responsive to a clip driver 76370. The clip driver76370 is configured to rotate relative to the outer tube 76305 inresponse to rotary motions generated by the motor within the housing ofthe clip applier 76300. The clip driver 76370 is housed within anopening in the jaw driver 76360 such that the clip driver 76370 and thejaw driver 76360 are co-axial. In other words, the clip driver 76370 andjaw driver 76360 comprise a nested rotary drive train. Further, both theclip driver 76370 and the jaw driver 76360 are operable independently ofone another via the motor of the clip applier 76300. The articulationtube portion 76350, the jaw driver 76360, and the clip driver 76370 areconfigured to bend and/or flex as the outer tube 76305 is articulated.The jaw driver 76360 and the clip driver 76370 may be comprised of dualwoven cables which provide torsional force no matter the direction thejaw driver 76360 and clip driver 76370 are rotated, for example. Invarious instances, the jaw driver 76360 and the clip driver 76370 mayprovide equal torsional force no matter the direction they are rotated,for example.

FIG. 123 depicts a clip applier 76300′ in accordance with at least oneembodiment. The clip applier 76300′ is similar in many respects to theclip applier 76300. For example, the clip applier 76300′ comprises a jawdriver 76360′ and a clip driver 76370′ which perform the same endeffector functions as the jaw driver 76360′ and the clip driver 76370′,respectively. However, the jaw driver 76360′ and the clip driver 76370′may be comprised of wire tubing which provides a different torsionalforce depending on the direction the jaw driver 76360′ and the clipdriver 76370′ are rotated, for example. Other embodiments are envisionedwhere the jaw drivers 76360 and 76360′ and/or the clip drivers 76370 and76370′ are comprised of dual woven cables and/or wire tubing andcombinations thereof. In other words, construction of the tubes orshafts (e.g., the jaw drivers 76360, 76360′ or the clip drivers 76370,76370′) could be selected based on the amount of torque required toperform a specific end effector function such as feeding a clip orcrimping a clip, for example. Notably, dual woven cables may be morecompatible with higher loads in both directions, and wire tubing (i.e.,wound springs, for example) may be better suited to transmit torsionalloads in one direction better than another. More specifically, wiretubing is wound in a specific direction; thus, less force is required torotate the wire tubing in the direction of the windings as compared torotating the wire tubing in the direction opposite the windings.Further, dual woven cables may comprise windings woven together inopposite directions; thus, it will require the same amount of force torotate the dual woven cable in either direction if the windings arebalanced, for example.

FIG. 124 depicts a rotary input 76400 in accordance with at least oneembodiment. The rotary input 76400 may be utilized to drive distal headfunctions of any of the clip appliers discussed herein. The rotary input76400 comprises an outer hollow tube 76410 and an inner hollow tube76420 which rotate together. The inner hollow tube 76420 is housedinside the outer hollow tube 76410. The outer hollow tube 76410comprises a plurality of coiled springs 76412 wound in a firstdirection. The inner hollow tube 76420 comprises a plurality of coiledsprings 76422 wound in a second direction opposite the first direction.The plurality of coiled springs 76412 are interlocked with the pluralityof coiled springs 76422. More specifically, each of the coiled springs76422 in the inner hollow tube 76420 are flanked by a pair of coiledsprings 76412 of the outer hollow tube 76410 such that each of thecoiled springs in the inner hollow tube 76420 are intermediate the pairof coiled springs 76412 of the outer hollow tube 76410 such that torqueis transmitted therebetween.

In at least one alternative embodiment, a clip applier may comprise arotary input comprising solid wall tubes that are laser cut to create aninterlocking pattern. The interlocking pattern provides a preferredrotational direction for the rotary input. Further, such a rotary inputis relatively flexible to facilitate articulation of the end effectorabout an articulation joint as described in further detail in U.S.patent application Ser. No. 13/536,232, filed on Jun. 28, 2012, which isincorporated by reference in its entirety.

FIG. 125 depicts a clip applier 77000 in accordance with at least oneembodiment. The clip applier 77000 comprises a shaft 77010 extendingfrom a housing, an end effector 77050 (see FIG. 141A) extending from theshaft 77010, a clip magazine 77020, and a clip advancer 77030. The clipmagazine 77020 and the clip advancer 77030 are housed within the shaft77010. The clip magazine 77020 is configured to translate and rotaterelative to the shaft 77010 in response to a translating motiontransmitted from the housing. The clip advancer 77030 is configured totranslate relative to the shaft 77010 when the clip magazine 77020 istranslated as the clip advancer 77030 is translatably coupled to theclip magazine 77020. The clip magazine 77020 is configured to store aplurality of clips 77004 in a plurality of clip slots 77022 positionedradially around the clip magazine 77020. Each clip slot 77022 comprisesa clip spring 77025 configured to bias a clip 77004 out of the clipmagazine 77020.

The clip advancer 77030 comprises a slot 77036, a proximal feeder spring77032, and a distal feeder spring 77034. As discussed below, theproximal feeder spring 77032 and the distal feeder spring 77034 advanceand hold clips in position as the clips are advanced into the endeffector 77050. The shaft 77010 comprises a stationary spring 77018extending into a loading slot 77015 of the shaft 77010. The loading slot77015 is configured to temporarily store a clip 77004 before the clip isadvanced into the end effector 77050 of the clip applier 77000. Theshaft 77010 comprises a groove 77012 comprising a translation portion77014 and a rotation portion 77016. The clip magazine 77020 comprisespins 77024 configured to ride within the groove 77012 in order totranslate and rotate the clip magazine 77020, as described in greaterdetail below.

When the clip magazine 77020 is in a proximal position, referring againto FIG. 125, the pins 77024 of the clip magazine 77020 are located in aproximal portion of the translation portion 77014 of the groove 77012.As the clip magazine 77020 is translated distally to a distal position,as illustrated in FIG. 126, the clip magazine 77020 and the clipadvancer 77030 translate together distally and the pins 77024 ridewithin the translation portion 77014 of the groove 77012. As the clipmagazine 77020 translates to the distal position (FIG. 126), the clipslot 77022 of the clip magazine 77020 will align with the loading slot77015 of the shaft 77010 and the clip spring 77025 will bias the clip77004 into the loading slot 77015, as illustrated in FIG. 126. When theclip magazine 77020 is retracted from the distal position toward theproximal position, as illustrated in FIG. 127, the pins 77024 of theclip magazine 77020 are configured to ride within the rotation portion77016 of the groove 77012 to rotate the clip magazine 77020 relative tothe shaft 77010 and retract the clip magazine 77020 to the proximalposition. As the clip magazine 77020 rotates and translates proximally,the clip 77004 in the loading slot 77015 is left behind in the loadingslot 77015, as illustrated in FIG. 128. At such point, the clip 77004can be advanced into the end effector 77050.

As the clip magazine 77020 and the clip advancer 77030 are translateddistally from the proximal position to the distal position, the proximalfeeder spring 77032 will engage the clip 77004 in the loading slot 77015and translate the clip 77004 distally into a staging position 77017within the shaft 77010 of the clip applier 77000, as illustrated inFIGS. 129-131. As the proximal feeder spring 77032 pushes the clip 77004distally, referring to FIG. 132, the clip 77004 engages the stationaryspring 77018 which biases the clip 77004 from the loading slot 77015into the staging position 77017. As the clip advancer 77030 and the clipmagazine 77020 are retracted, the clip 77004 will remain in the stagingposition 77017, as illustrated in FIG. 133. The staging position 77017comprises a slot, or any suitable means of holding the clip 77004.

Referring now to FIGS. 134-136, after the clip 77004 is positioned inthe staging position 77017, the clip magazine 77020 can be translatedagain to the distal position to advance the clip 77004 into a clip track77052 (see FIG. 141A). More specifically, as the clip magazine 77020 ismoved toward the distal position, the distal feeder spring 77034 of theclip advancer 77030 will engage the clip 77004 and advance the clip77004 from the staging position 77017 (see FIG. 134) into the clip track77052 (see FIG. 136).

As discussed above, the clip magazine 77020 is configured to hold aplurality of clips 77004. However, only one clip 77004 is shown in FIGS.125-136 in order to show how the clip 77004 is advanced by the clipadvancer 77030 and clip magazine 77020. Referring primarily to FIG. 137,with each retraction of the clip magazine 77020 from the distal positionto the proximal position the clip magazine 77020 will rotate, asdiscussed above. Thus, when the clip 77004 is advanced into the loadingslot 77015 and the clip advancer 77030 and clip magazine 77020 areretracted, the clip magazine 77020 will rotate relative to the clipadvancer 77030 to align a second clip 77005 with the slot 77036 of theclip advancer 77030. Thereafter, the second clip 77005 is advanced bythe clip advancer 77030 into the loading slot 77015 while the clip 77004is advanced by the proximal feeder spring 77032 into the stagingposition 77017, as discussed above. The clip advancer 77030 and clipmagazine 77020 can then be retracted again while leaving the clip 77004in the staging position 77017 and leaving the second clip 77005 in theloading slot 77015. When the clip magazine 77020 is retracted, onceagain, it will rotate once again, and thus, a third clip 77006 can bealigned with the slot 77036 of the clip advancer 77030. The third clip77006 can then be advanced by the clip advancer 77030 toward the loadingslot 77015 when the clip magazine 77020 is moved toward the distalposition.

Referring now to FIG. 138, as the third clip 77006 is advanced into theloading slot 77015, the proximal feeder spring 77032 of the clipadvancer 77030 will advance the second clip 77005 from the loading slot77015 into the staging position 77017. Further, the clip 77004positioned in the staging position 77017 will be advanced by the distalfeeder spring 77034 into the clip track 77052. Referring now to FIG.139, when the clip magazine 77020 is then retracted to the proximalposition, it will rotate and align a fourth clip 77007 with the slot77036 of the clip advancer 77030. The fourth clip 77007 can then beadvanced into the loading slot 77015 while the third clip 77006 in theloading slot 77015 is advanced into the staging position 77017 (see FIG.140). Further, while the fourth clip 77007 is advanced toward theloading slot 77015 the clips 77004, 77005 are advanced distally by thedistal feeder spring 77034 (see FIG. 140). More specifically, the distalfeeder spring 77034 engages the second clip 77005 and advances thesecond clip 77005 from the staging position 77017 into the clip track77052. The second clip 77005 engages the backside of the clip 77004 suchthat the second clip 77005 advances the clip 77004.

Further to the above, the clip magazine 77020 can be retracted to rotatethe clip magazine once again, which will align a fifth clip 77008 (seeFIG. 141A) with the slot 77036 of the clip advancer 77030. The fifthclip 77008 can then be advanced into the loading slot 77015 while thefourth clip 77007 is advanced into the staging position 77017 and thethird clip 77006 is advanced into the clip track 77052. The third clip77006 engages the backside of the second clip 77005 and thus advancesthe second clip 77005 and the first clip 77004 through the clip track77052. The stroke of the clip advancer 77030 and clip magazine 77020 issuch that the clips are advanced through the clip track 77052 one cliplength at a time. Other embodiments are envisioned with different clipadvancer 77030 and clip magazine 77020 strokes, among other things.Further operation of the clip applier 77000 is discussed in greaterdetail below.

Referring primarily to FIGS. 141A-141C, the clip applier 77000 furthercomprises a jaw cam 77060 configured to actuate the end effector 77050.The end effector 77050 comprises a first jaw 77054 and a second jaw77056 which at least partially define a receiving chamber 77055 thereinand are movable relative to each other between an open position and aclosed position. The end effector 77050 further comprises a proximalportion 77058 extending proximally from the first jaw 77054 and thesecond jaw 77056. The proximal portion 77058 is attached to the shaft77010 via a laterally extending pin fixed within the distal end of theshaft 77010 such that the end effector 77050 is mounted to the shaft77010. The jaw cam 77060 is configured to translate along the proximalportion 77058 of the end effector 77050 between a proximal position (seeFIG. 141A) and a distal position (see FIG. 141C). The jaw cam 77060 isthreadably engaged with a rotary input, such that rotation of the rotaryinput will translate the jaw cam 77060. The rotary input is operablyresponsive to rotary motions generated within the housing of clipapplier 77000. The jaw cam 77060 is rotatably constrained by theproximal portion 77058 of the end effector 77050, such that, when therotary input is rotated, the jaw cam 77060 is translated. The first jaw77054 and the second jaw 77056 remain in the open position when the jawcam 77060 is moved between the proximal position and the distalposition; however, the jaw cam 77060 can be moved beyond the distalposition to cammingly engage the first jaw 77054 and the second jaw77056 to move the first jaw 77054 and the second jaw 77056 toward theclosed position as described in greater detail below.

The jaw cam 77060 is slidably coupled to a feeder shoe 77062 extendingdistally from the jaw cam 77060. The jaw cam 77060 and the feeder shoe77062 are configured to advance a clip from the clip track 77052—if aclip is present in the clip track—into the receiving chamber 77055 ofthe end effector 77050. The jaw cam 77060 comprises a pin 77065extending into a slot 77064 of the feeder shoe 77062 (see FIG. 142). Thefeeder shoe 77062 further comprises a biasing member, such as a spring77061, for example, extending proximally from the distal end of the slot77064 which is engaged with the pin 77065 of the jaw cam 77060 such thatthe feeder shoe 77062 is biased distally by the spring 77061. In otherwords, the spring 77061 acts to keep the pin 77065 positioned in theproximal end of the slot 77064.

Further to the above, when the jaw cam 77060 is moved from the proximalposition to the distal position the feeder shoe 77062 advances a clip—ifa clip is present in the clip track 77052—into the receiving chamber77055 of the end effector 77050. More specifically, when the jaw cam77060 translates distally, the distal end of the feeder shoe 77062engages the backside of a clip in the clip track 77052 to advance theclip (see FIG. 143). The biasing force of the spring 77061 is notovercome by translating the clip into the end effector 77050; thus, thefeeder shoe 77062 moves with the jaw cam 77060 as the jaw cam 77060translates to the distal position. When the jaw cam 77060 is moved tothe distal position, the feeder shoe 77062 is stopped from furtheradvancement by a distal stop 77057 protruding from the clip track 77052.More specifically, the feeder shoe 77062 comprises a protrusion 77063extending toward the clip track 77052 that engages the distal stop 77057to prevent further distal translation of the feeder shoe 77062. The jawcam 77060 can then be translated further, beyond the distal position, tocammingly engage the first jaw 77054 and the second jaw 77056 of the endeffector 77050 to crimp the clip positioned in the receiving chamber77055. In other words, the feeder shoe 77062 will not translate with thejaw cam 77060 when the jaw cam 77060 translates beyond the distalposition. As the rotary input continues to drive the jaw cam 77060distally, the biasing force of the spring 77061 is overcome and the pin77065 of the jaw cam 77060 will translate distally through the slot77064 of the feeder shoe 77062 as the feeder shoe 77062 is preventedfrom distally translating via the distal stop 77057. In such instances,the spring 77061 is compressed to allow the jaw cam 77060 to translatedistally without further advancing the feeder shoe 77062.

Further to the above, as the jaw cam 77060 retracts from beyond thedistal position to the distal position, the spring 77061 will bias thefeeder shoe 77062 proximally such that the pin 77065 is once againpositioned in the proximal end of the slot 77064. Also, the first jaw77054 and the second jaw 77056 will be moved from the closed position tothe open position to release the crimped clip from the end effector77050. The pin 77065 will remain in the proximal end of the slot 77064as the jaw cam 77060 is retracted from the distal position to theproximal position due to the biasing force of the spring 77061 asdiscussed above. Thus, the jaw cam 77060 and feeder shoe 77062 areretractable together to position the feeder shoe 77062 behind anotherclip in the clip track 77052. More specifically, the distal end of thefeeder shoe 77062 comprises an angled portion 77067 which allows thefeeder shoe 77062 to slide up and over the next clip positioned in theclip track 77052. Further, the clip track 77052 comprises a proximalstop 77053 at its proximal end that prevents further proximaltranslation of the feeder shoe 77062, i.e., via the protrusion 77063 onthe feeder shoe 77062. The proximal stop 77053 ensures that the distalend of the feeder shoe 77062 is aligned with the backside of the nextclip in the clip track 77052.

The clip advancer 77030 and the jaw cam 77060 can be independentlysequenced, i.e., intermittently actuated by the motor, in order to movethe first jaw 77054 and the second jaw 77056 between the open and closedpositions without advancing a clip into the end effector 77050. In suchinstances, the clip advancer 77030 can be prevented from being actuatedwhile the jaw cam 77060 is being actuated. Thus, the jaw cam 77060 canopen and/or close the first jaw 77054 and the second jaw 77056 without aclip positioned in between the first jaw 77054 and the second jaw 77056until the clip advancer 77030 has been actuated. In at least oneinstance, the jaw cam 77060 can be utilized to open and/or close thefirst jaw 77054 and the second jaw 77056 a predetermined number of timesbefore the clip advancer 77030 is actuated to feed a clip. In certaininstances, after advancing a clip (or several clips) into the endeffector 77050 for crimping between the first jaw 77054 and the secondjaw 77056, the sequence between the jaw cam 77060 and the clip advancer77030 can be interrupted so as to not advance another clip into the cliptrack 77052. The jaw cam 77060 and feeder shoe 77062 can advance andcrimp the clip or clips remaining in the clip track 77052 until the cliptrack 77052 is empty. With the clip track 77052 empty, the jaw cam 77060can be moved between the proximal position and the distal position asneeded without the feeder shoe 77062 engaging a clip. The clip advancer77030 can then be actuated again to advance more clips into the cliptrack 77052 for engagement with the feeder shoe 77062. In other words,the clip applier 77000 is capable of intermittently advancing clips intothe end effector 77050 such that the first jaw 77054 and the second jaw77056 can be actuated with or without a clip present, even after a cliphas already been advanced and crimped.

FIGS. 144A-144C depict a clip applier 77000′ in accordance with at leastone embodiment. The clip applier 77000′ is similar in many respects tothe clip applier 77000. More specifically, the clip applier 77000′comprises a jaw cam 77060′ configured to move the first jaw 77054 andthe second jaw 77056 of the end effector 77050 between the open positionand the closed position, as discussed above. The jaw cam 77060′comprises a body portion 77062′ configured to threadably engage a rotaryinput 77070′ that is operably responsive to rotary motions generatedinside the housing of the clip applier 77000′. As the rotary input77070′ is rotated, the jaw cam 77060′ will translate to move the firstjaw 77054 and the second jaw 77056 between the open position and theclosed position.

Further to the above, the body portion 77062′ comprises a protrusion77066′ extending laterally therefrom. The protrusion 77066′ isconfigured to extend into a proximal opening 77069′ of a clip advancer77064′ to releasably engage the body portion 77062′ with the clipadvancer 77064′. Other embodiments are envisioned where the clipadvancer 77064′ and the body portion 77062′ are releasably attachablewith a spring clip, or any other suitable means, for example. In anyevent, the clip advancer 77064′ comprises a feeder shoe 77067′ extendingdistally therefrom. The feeder shoe 77067′ is configured to advance aclip (one of the clips 77004, 77005, 77006, 77007, 77008, for example)from the clip track 77052 into the receiving chamber 77055 of the endeffector 77050 as the body portion 77062′ moves from a proximal position(FIG. 144A) to a distal position (FIG. 144B). During the translation ofthe body portion 77062′ between the proximal position and the distalposition, the first and second jaws 77054, 77056 are not approximated(i.e., they remain open).

Further to the above, the body portion 77062′ can advance beyond thedistal position (FIG. 144B) to a closing position (see FIG. 144C) inresponse to further rotation of the rotary input 77070′. As the bodyportion 77062′ moves toward the closing position, it will camminglyengage the outer surfaces of the first jaw 77054 and the second jaw77056 to move the first jaw 77054 and the second jaw 77056 toward theclosed position. Once the clip 77004 has been advanced into thereceiving chamber 77055, the distal end of the feeder shoe 77067′ of theclip advancer 77064′ is abutted against the clip 77004 and the clip77004 is abutted against a distal stop 77059 preventing further distaladvancement of the clip advancer 77064′. The distal stops 77059 arepositioned at the distal end of both the first jaw 77054 and the secondjaw 77056 and prevent the clip 77004 from translating distally out ofthe end effector 77050. Therefore, as the body portion 77062′ of the jawcam 77060′ is advanced beyond the distal position (FIG. 144B) to theclosing position (FIG. 144C), the protrusion 77066′ of the body portion77062′ moves from the proximal opening 77069′ of the clip advancer77064′ into a distal opening 77068′ of the clip advancer 77064′ becausethe clip advancer 77064′ is no longer translatable distally, asdiscussed above. In other words, the retention force between theproximal opening 77069′ and the protrusion 77066′ is overcome by thebody portion 77062′ when the body portion 77062′ is advanced from thedistal position (FIG. 144B) toward the closing position (FIG. 144C).Thus, the body portion 77062′ and clip advancer 77064′ are translatabletogether to advance a clip into the end effector 77050 and then the bodyportion 77062′ can be advanced further distally to move the first jaw77054 and the second jaw 77056 to the closed position without furtheradvancement of the clip advancer 77064′.

FIGS. 145-150 depict a clip applier 77100 in accordance with at leastone embodiment. The clip applier 77100 comprises a shaft 77120, a clipmagazine 77110, a clip advancer 77130, and a feeder shoe 77140. Theshaft 77120 extends from a housing of the clip applier 77100 and definesa shaft axis SA. The clip magazine 77110 is configured to translaterelative to the shaft 77120 between a proximal position (see FIGS. 146and 150) and a distal position (see FIG. 148) in response to therotational output of a motor within the housing of the clip applier77100. Similar to the above, the clip magazine 77110 is furtherconfigured to store a plurality of clips 77104 in a plurality of clipstorage positions 77112. The clip magazine 77110 further comprises aboss 77114 extending from its distal end. The clip advancer 77130 isrotatably mounted on the boss 77114 of the clip magazine 77110 such thatthe clip advancer 77130 is rotatable relative to the clip magazine 77110and translatable with the clip magazine 77110. The clip advancer 77130is configured to translate a clip 77104 through a clip track 77106 inresponse to a translation of the clip magazine 77110 as described ingreater detail below.

The shaft 77120 of the clip applier 77100 comprises an annular groove77124 on the inside diameter 77122 of the shaft 77120. The annulargroove 77124 is configured to slidably receive a protrusion 77138extending from a camming member 77132 of the clip advancer 77130. Theannular groove 77124 is defined in the inside diameter 77122 of theshaft 77120 to provide a spiral travel path for the protrusion 77138 ofthe camming member 77132. The spiral travel path of the annular groove77124 is in a first direction. The camming member 77132 extendslaterally relative to the shaft axis SA from a body portion 77131 of theclip advancer 77130. The camming member 77132 comprises an annular slot77134 configured to slidably receive a protrusion 77141 extending fromthe proximal end of the feeder shoe 77140. The annular slot 77134 isformed into the camming member 77132 to provide a spiral travel path forthe protrusion 77141 extending from the feeder shoe 77140. The spiraltravel path of the annular groove 77124 of the shaft 77120 and thespiral travel path of the annular slot 77134 of the camming member 77132are in opposite directions.

The clip advancer further comprises a recess 77136 between the cammingmember 77132 and the body portion 77131. The recess 77136 providesclearance for the feeder shoe 77140 to translate relative to the clipadvancer 77130. More specifically, when the protrusion 77141 of thefeeder shoe 77140 is captured in the annular slot 77134 of the cammingmember 77132, the feeder shoe 77140 is positioned within the recess77136.

Further to the above, the feeder shoe 77140 comprises a dovetail portion77144 extending from the distal end of the feeder shoe 77140. Thedovetail portion 77144 is captured in a longitudinal groove 77126defined in the inside diameter 77122 of the shaft 77120. Thelongitudinal groove 77123 comprises a complementary shape to thedovetail portion 77144 such that the dovetail portion 77144 is retainedwithin and slidable along the longitudinal groove 77123. The feeder shoe77140 further comprises a clip feeder 77146 extending downward from itsproximal end. The clip feeder 77146 is configured to feed a clip 77104through the clip track 77106 of the clip applier 77100 when the clipmagazine 77110 is translated distally as discussed in greater detailbelow.

Referring again to FIGS. 146-150. The protrusion 77138 extending fromthe camming member 77132 is configured to travel through the annulargroove 77124 of the shaft 77120 and the protrusion 77141 of the feedershoe 77140 is configured to travel through the annular slot 77134 of thecamming member 77132 when the clip magazine 77110 is translated betweenits proximal position and its distal position. Referring primarily toFIG. 146, the clip magazine 77110 is in the proximal position and a clip77104 is abutted against the clip feeder 77146 of the feeder shoe 77140.As the clip magazine 77110 is translated distally (see FIG. 147), theclip advancer 77130 will rotate due to the protrusion 77138 beingconstrained within the annular groove 77124 of the shaft 77120. Asdiscussed above, the feeder shoe 77140 is constrained to longitudinalmovement by the longitudinal groove 77126 and dovetail portion 77144 ofthe feeder shoe 77140. Thus, as the clip advancer 77130 rotates, theclip advancer 77130 will translate the feeder shoe 77140 distally due tothe sidewalls of the annular slot 77134 engaging the protrusion 77141 ofthe feeder shoe 77140 as the annular slot 77134 is rotated. As thefeeder shoe 77140 translates distally, the feeder shoe 77140 willtranslate the clip 77104 distally via the clip feeder 77146. Further,when the clip magazine moves from the proximal position to the distalposition, it moves through a stroke length SL₁ and the feeder shoe 77140moves through a stroke length SL₂ (see FIGS. 151A and 151B). The strokelength SL₂ of the feeder shoe 77140 is twice the stroke length SL₁ ofthe clip magazine 77110. Other embodiments are envisioned where thestroke length SL₂ is more than or less than twice the stroke length SL₁,for example. In various instances, the pitches of the annular groove77124 and the annular slot 77134 can be constructed to modify the strokelengths SL₁ and SL₂, for example.

Further to the above, as the clip magazine 77110 translates into thedistal position (FIG. 148), the above-described rotation of the clipadvancer 77130 will continue until the protrusion 77138 of the clipadvancer 77130 reaches the end of the annular groove 77124—thuspreventing further rotation of the clip advancer 77130. Further, thedistal translation of the feeder shoe 77140 will continue until theprotrusion 77141 reaches the end of the annular slot 77134 of the clipadvancer 77130—thus preventing further distal translation of the feedershoe 77140. Correspondingly, the clip magazine 77110 can be translatedproximally toward the proximal position (see FIG. 149) to partiallyretract the feeder shoe 77140. Further proximal translation of the clipmagazine 77110 to the proximal position (see FIG. 150) will completelyretract the feeder shoe 77140.

FIGS. 152 and 153 depict a clip applier 77200 in accordance with atleast one embodiment. The clip applier 77200 comprises a shaft 77220extending from a housing of the clip applier 77200, a clip magazine77210 extending from the shaft 77220, a clip advancer 77230 extendingfrom the clip magazine 77210, a firing drive 77250, and an end effector77240. The clip magazine 77210 defines a magazine axis MA. The clipmagazine 77210 is configured to rotate about the magazine axis MA. Thefiring drive 77250 is also aligned with, and is rotatable about, themagazine axis MA in response to rotary motions generated by a motorwithin the housing of the clip applier 77200. The clip magazine 77210comprises clip holders 77212 circumferentially positioned approximately120 degrees apart about the magazine axis MA. The clip holders 77212 areconfigured to store a plurality of clips for clipping tissue. Each ofthe clip holders 77212 is configured to align with a clip track 77232 ofthe clip advancer 77230 as the clip magazine 77210 rotates about themagazine axis MA between a plurality of ejection positions. For example,one of the ejection positions is illustrated in FIG. 153, i.e., a clipholder 77212 is aligned with the clip track 77232. When the clipmagazine 77210 is in an ejection position, the clip magazine 77210 isconfigured to bias a clip from the clip magazine 77210 into the cliptrack 77232. Once a clip is positioned in the clip track 77232, it canbe advanced into the end effector 77240 by a feeder shoe 77270. Thefeeder shoe 77270 is translatable through the clip track 77232 relativeto the shaft 77220 in response to rotary motions generated within thehousing of the clip applier 77200.

Further to the above, the end effector 77240 comprises a proximalportion 77245 configured to extend through a first opening 77234 in theclip advancer 77230 and a second opening 77216 in the clip magazine77210. The proximal portion 77245 comprises a first arm 77246 and asecond arm 77248 which extend through the first opening 77234 in theclip advancer 77230 and the second opening 77216 in the clip magazine77210. The end effector 77240 further comprises a proximal anchor 77249extending through the first opening 77234 in the clip advancer 77230 andthrough slots 77214 of the clip magazine 77210. The slots 77214 areradially disposed approximately 120 degrees apart within the clipmagazine 77210 about the magazine axis MA. The slots 77214 extend awayfrom the second opening 77216 to provide clearance for the proximalanchor 77249 of the end effector 77240. Further, the first arm 77246 andthe second arm 77248 are chamfered to provide clearance for the firingdrive 77250.

Further to the above, the end effector 77240 further comprises a firstjaw 77242 extending distally from the first arm 77246 of the proximalportion 77245, and a second jaw 77244 extending distally from the secondarm 77248 of the proximal portion 77245. The first arm 77246 and thesecond arm 77248 of the proximal portion 77245 are coupled together viaa collar 77260. The first arm 77246 and the second arm 77248 extend awayfrom each other, at least partially, due to their connection via theproximal anchor 77249. The collar 77260 is advanceable from a proximalposition to a distal position to move the first arm 77246 and the secondarm 77248 together, or toward one another. In such instances, the firstjaw 77242 and the second jaw 77244 are movable between an open position(as illustrated in FIG. 152) and a closed position in response to thedistal movement of the collar 77260. Further, the first jaw 77242 andthe second jaw 77244 extend down from a center plane CP (see FIG. 155)of the proximal portion 77245 such that the firing drive 77250, thefirst arm 77246 and the second arm 77248 of the proximal portion 77245,and the first jaw 77242 and the second jaw 77244 are positioned ondifferent planes of the clip applier 77200. The first jaw 77242 and thesecond jaw 77244 at least partially define a receiving chamber 77241configured to receive a clip from the clip magazine 77210.

The above-described arrangement allows a clip to be fed into the jaws ofthe end effector 77240 along a plane that is offset from the magazineaxis MA. The jaws of the end effector are angled toward the magazineaxis MA at their distal end, as illustrated in FIG. 152, to allow a clippositioned therein to be crimped in a plane that is closer to themagazine axis MA than the plane by which the clip was fed into the endeffector 77240. This allows a different input other than the feedershoe, such as the firing drive 77250, to extend through the clipmagazine 77210 while crimping the clips on a plane that is coincident,or close to coincident, with the magazine axis MA.

FIGS. 156 and 157 depict a clip applier 77300 in accordance with atleast one embodiment. The clip applier comprises an elongate tube 77320extending from a housing of the clip applier 77300, a clip magazine77310 housed within the elongate tube 77320, and an end effector 77340.The clip magazine 77310 comprises a central opening 77316 that defines amagazine axis MA. The clip magazine 77310 is configured to translatealong and rotate about the magazine axis MA. The clip magazine 77310further comprises clip slots 77312 radially disposed approximately 120degrees apart about the magazine axis MA. The clip slots 77312 areconfigured to store a plurality of clips which are biased out of theclip magazine 77310. The clips can be biased out of the clip magazine77310 by any suitable biasing member, including the biasing membersdiscussed herein, for example. The elongate tube 77320 further comprisesan opening 77322 which provides clearance for a clip from the clipmagazine 77310 to be biased from the clip magazine 77310 onto a cliptrack when one of the clip slots 77312 is aligned with the opening77322. The clip can be advanced through the clip track into the endeffector by a feeder shoe, as described herein.

Referring primarily to FIG. 156, the end effector 77340 comprises afirst jaw 77342, a second jaw 77344, and a proximal portion 77345extending proximally from the first jaw 77342 and the second jaw 77344.The first jaw 77342 and the second jaw 77344 at least partially define areceiver 77341 configured to receive a clip from the clip track when theclip is advanced by the feeder shoe, as discussed above. The proximalportion 77345 is configured to attach the end effector 77340 to theelongate tube 77320. The proximal portion 77345 comprises a firstsupport 77346 extending proximally from the first jaw 77342 and thesecond jaw 77344. The first support 77346 is located below the magazineaxis MA, as discussed in greater detail below.

The proximal portion 77345 further comprises a second support 77348located between the magazine axis MA and the first support 77346. Otherembodiments are envisioned where the second support 77348 is located atand/or above the magazine axis MA, for example. In any event, theproximal portion 77345 comprises a U-shaped portion connecting the firstsupport 77346 and the second support 77348 at their proximal ends. Theelongate tube 77320 further comprises a lateral bar 77324 positioned atthe distal end of the elongate tube 77320 and spanning across the insidediameter 77326 of the elongate tube 77320. The U-shaped portion 77347 isconfigured to receive the lateral bar 77324 to connect the proximalportion 77345 of the end effector 77340 to the elongate tube 77320.

Further to the above, and with regard to FIGS. 158 and 159, the clipapplier 77300 further comprises a collar 77360 mounted around the firstsupport 77346 of the proximal portion 77345 of the end effector 77340.The collar 77360 is formed around the first support 77346 after theproximal portion 77345 of the end effector 77340 is attached to theelongate tube 77320, as discussed above. More specifically, the collar77360 comprises a first bendable side 77364 and a second bendable side77365. The first bendable side 77364 comprises a groove 77366 and thesecond bendable side 77365 comprises a protrusion 77367. The first andsecond bendable sides 77364, 77365 are bent around the first support77346 and attached together below the first support 77346. Morespecifically, the protrusion 77367 engages the groove 77366 to slidablysecure the collar 77360 to the proximal portion 77345 of the endeffector 77340. In at least one alternative embodiment, the assembledcollar 77360 is attached to the end effector 77340 prior to attachingthe end effector 77340 to the elongate tube 77320. More specifically,the collar 77360, after being assembled in the above-described manner,is slid onto the proximal portion 77345 of the end effector 77340 priorto bending the second support 77348 relative to the first support 77346.Once the collar 77360 is attached to the proximal portion 77345, thesecond support 77348 can be bent relative to the first support 77346 toform the U-shaped portion 77347. The end effector 77340 is then attachedto the elongate tube 77320 in the above-described manner. Operation ofthe collar 77360 is discussed in greater detail below.

The collar 77360 is configured to cammingly engage the first jaw 77342and the second jaw 77344 as the collar 77360 moves from a proximalposition to a distal position. In such instances, the first jaw 77342and the second jaw 77344 are movable relative to each other between anopen position and a closed position as the collar 77360 moves from theproximal position to the distal position. The collar 77360 comprises aprotrusion 77362 extending toward the magazine axis MA. The protrusion77362 comprises a threaded aperture 77343 (see FIG. 158) that isthreadably engaged with a collar driver. The collar driver is configuredto move the collar 77360 between the proximal position and the distalposition in response to rotary motions generated within the housing ofthe clip applier 77300. The protrusion 77362 extends within an opening77349 in the second support 77348. In fact, the opening 77349 extendsinto the U-shaped portion 77347 to provide clearance for the collardriver to extend proximally through the central opening 77316 of theclip magazine 77310. This arrangement allows the clip magazine 77310 torotate about the magazine axis MA, while the collar 77360 is translatedalong an axis parallel to, but offset from, the magazine axis MA. Asillustrated in FIG. 157, the jaws of the end effector 77340 are angledtoward the magazine axis MA at their distal end to allow a clippositioned therein to be crimped in a plane that is closer to themagazine axis MA than the plane by which the clip was fed into the endeffector 77340. This allows a different input other than the feedershoe, such as the collar driver, to extend through the clip magazine77310 while still allowing the clips to be crimped on a plane that iscoincident, or substantially coincident, with the magazine axis MA.

Referring now to FIG. 160, an alternative end effector 77340′ for usewith the clip applier 77300 is depicted. The end effector 77340′ issimilar to the end effector 77340 in many respects. The end effector77340′ comprises a first protrusion 77342 a extending from the first jaw77342, and a second protrusion 77344 b extending from the second jaw77344. The first protrusion 77342 a and the second protrusion 77344 bare angled relative to one another such that their proximal ends arecloser together than their distal ends. The end effector 77340′ isconfigured for use with a cam member 77370 that comprises a first slot77372 oriented transversely relative to the first protrusion 77342 a anda second slot 77374 oriented transversely relative to the secondprotrusion 77344 b. The cam member 77370 is movable between a proximalposition and a distal position by a cam member driver in response torotary motions generated within the housing of the clip applier 77300.More specifically, the cam member driver is threadably engaged with thecam member 77370 via a threaded aperture 77376 defined in the cam member77370 such that, as the cam member driver rotates, the cam member 77370translates. As the cam member 77370 moves from the proximal position tothe distal position, the sidewalls of the first slot 77372 and thesecond slot 77374 will engage the protrusions 77342 a, 77344 b. Becausethe protrusions 77342 a, 77344 b are angled relative to the slots 77372,77374, the cam member 77370 will bias the first jaw 77342 and the secondjaw 77344 toward a closed position as the cam member 77370 moves fromthe proximal position to the distal position. Further, the cam member77370 will bias the first jaw 77342 and the second jaw 77344 toward anopen position as the cam member 77370 moves from the distal position tothe proximal position.

FIGS. 161 and 162 depict a clip applier 77400 in accordance with atleast one embodiment. The clip applier 77400 comprises a clip applierhead, or end effector 77420, for example, extending from a shaft. Theend effector 77420 comprises a top portion 77422, a bottom portion77424, and an intermediate portion 77426 connecting the top portion77422 and the bottom portion 77424. The top portion 77422 and the bottomportion 77424 are in two different parallel, or at least substantiallyparallel planes. The bottom portion 77424 comprises a pair of opposingjaws 77421 extending distally therefrom. The pair of opposing jaws 77421at least partially define a receiving chamber 77428 therein. Theopposing jaws 77421 are movable between an open position and a closedposition by way of a camming member 77440 slidably attached to thebottom portion 77424 of the end effector 77420. The camming member 77440is rotatably constrained by the bottom portion 77424 and is threadablyengage with a drive screw 77430. The drive screw 77430 comprises adistal thread portion 77434, a proximal thread portion 77432, and anintermediate portion 77436 connecting the distal thread portion 77434and the proximal thread portion 77432.

Further to the above, the intermediate portion 77436 of the drive screw77430 is rotatably supported by, but not threadably engaged with, anopening in the intermediate portion 77426 of the end effector 77420. Thedistal thread portion 77434 is threadably engaged with the cammingmember 77440 such that rotation of drive screw 77430 in a firstdirection will translate the camming member 77440 distally. In addition,the proximal thread portion 77432 is threadably engaged with a feedershoe 77450 such that rotation of the drive screw 77430 in the firstdirection will translate the feeder shoe 77450 proximally. In otherwords, the distal thread portion 77434 and the proximal thread portion77432 are threaded in opposite directions. Moreover, the distal threadportion 77434 comprises a smaller thread pitch than the proximal threadportion 77432. As a result, for a given rotation of the drive screw77430, the camming member 77440 will translate less than the feeder shoe77450, for example. As the drive screw 77430 is rotated in the firstdirection, the camming member 77440 will translate from a proximalposition (see FIG. 161) to a distal position (see FIG. 162) and thefeeder shoe 77450 will translate from a distal position (see FIG. 161)to a proximal position (see FIG. 162). As the camming member 77440 ismoved toward the distal position, it will cammingly engage the pair ofopposing jaws 77421 and move the jaws 77421 to the closed position.Correspondingly, as the drive screw 77430 is rotated in a seconddirection, opposite the first direction, the camming member 77440 willtranslate from the distal position (see FIG. 162) to the proximalposition (see FIG. 161) and the feeder shoe 77450 will translate fromthe proximal position (see FIG. 162) to the distal position (see FIG.161). As the camming member 77440 is moved toward the proximal position,the pair of opposing jaws 77421 will move to the open position.

Further to the above, the clip applier 77400 further comprises a cliptrack 77410 configured to store a first clip 77404, a second clip 77405,and a third clip 77406. In at least one embodiment, the first clip77404, the second clip 77405, and the third clip 77406 can be fed intothe clip track 77410 by a clip magazine. The clips 77404, 77405, 77406are biased distally by a feeder block 77412 and a feeder spring 77413.The feeder shoe 77450 further comprises a feeder bar 77452 extendingdistally therefrom. The feeder bar 77452 comprises a first clip notch77454 located at the distal end thereof, and a second clip notch 77456located proximal to the first clip notch 77454. Operation of the clipapplier 77400 is described in greater detail below.

When the clip applier 77400 is initially loaded into a surgical sitethrough a trocar or cannula, for example (referring primarily to FIG.161), the opposing jaws 77421 can already have the first clip 77404positioned therein. In such instances, the second clip 77405 and thethird clip 77406 are located in the clip track 77410 and biased distallyby the feeder spring 77413. The second clip 77405 and the third clip77406 are held in place by the second clip notch 77456 of the feeder bar77452. The biasing force in this position from the feeder spring 77413is not enough to force the second clip 77405 out of the second clipnotch 77456 as the spring is in an expanded position. As the drive screw77430 is rotated in the first direction, the opposing jaws 77421 willmove toward the closed position and the feeder shoe 77450 will movetoward the proximal position, as discussed above. As the feeder shoe77450 is moved toward the proximal position, the first clip 77404 willbe crimped and the feeder shoe 77450 will retract the second clip 77405and the third clip 77406 proximally while compressing the feeder spring77413. The second and third clips 77405, 77406 will retract proximallyuntil the biasing force from the feeder spring 77413 overcomes theretention force between the second clip 77405 and the second clip notch77456. At this point, the second clip 77405 will slide by the secondclip notch 77456. However, the first clip notch 77454 will catch thesecond clip 77405. Moreover, the third clip 77406 will follow the secondclip 77405 by the second clip notch 77456 such that the feeder spring77413 is pushing on the second clip 77405 via the third clip 77406.

After the first clip 77404 has been crimped it can be released from thereceiving chamber 77428 by rotating the drive screw 77430 in the seconddirection. As discussed above, when the drive screw 77430 is rotated inthe second direction, the opposing jaws 77421 of the end effector 77420will move to the open position and the feeder shoe 77450 will movetoward the distal position. As the feeder shoe 77450 moves toward thedistal position the feeder bar 77452 will carry the second and thirdclips 77405, 77406 distally. The second and third clips 77405, 77406will remain biased into the first clip notch 77454 by the feeder spring77413 until the distal end of the feeder shoe 77450 approaches thereceiving chamber 77428 of the end effector 77420. The distal end of thefeeder shoe 77450 is configured to curve, or bend, upwardly as itapproaches the receiving chamber 77428 of the end effector 77420 and, asa result, the second clip 77405 is released from the first clip notch77454. Once the second clip 77405 is released, the feeder spring 77413biases the second clip 77405 into the receiving chamber 77428 of the endeffector 77420. At the same time, the third clip 77406 is biaseddistally by the feeder spring 77413 but cannot enter the receivingchamber 77428 because the receiver is occupied by the second clip 77405.In such instances, the third clip 77406 is staged for the next actuationof the clip applier as described below.

Further to the above, the drive screw 77430 can now be rotated in thefirst direction to crimp the second clip 77405 positioned in thereceiving chamber 77428 and retract the feeder bar 77452 via the feedershoe 77450, as discussed above. As the feeder bar 77452 is retracted,the first clip notch 77454 will engage the third clip 77406 and retractthe third clip 77406 proximally (see FIG. 162). At this stage, thefeeder shoe 77450 is in the proximal position once again, the cam member77440 is in the distal position once again, the second clip 77405 hasbeen crimped by the opposing jaws 77421, and the third clip 77406 hasbeen retracted. The drive screw 77430 can now be rotated in the firstdirection to release the second clip 77405 from the opposing jaws 77421of the end effector 77420 and to advance the third clip 77406 into theopposing jaws 77421 by way of the feeder bar 77452, in the mannerdiscussed above in connection with the second clip 77405. The third clip77406 can then be crimped by rotating the drive screw 77430 in thesecond direction and then the crimped third clip 77406 can be releasedfrom the opposing jaws 77421 by rotating the drive screw 77430 in thefirst direction.

The above-discussed embodiment of FIGS. 161 and 162 comprises a systemfor automatically loading a plurality of clips into an end effectorafter the first clip has been crimped and released. The clips loadedinto the end effector are then sequentially crimped and released.

FIGS. 163 and 164 depict a clip applier 77500 in accordance with atleast one embodiment. The clip applier comprises an end effector 77520,an actuator 77510, and a drive screw 77530 extending proximally from theactuator 77510. The actuator 77510 comprises a drive bar 77511 and athreaded nut 77514 at the proximal end of the drive bar 77511. The drivebar 77511 comprises internal threads 77512 configured to receive theexternal threads 77532 of the drive screw 77530. The actuator 77510 isrotatably constrained within a shaft of the clip applier 77500 by thethreaded nut 77514 thus, the drive screw 77530 can be rotated totranslate the actuator 77510 between a proximal position (FIG. 163) anda distal position (FIG. 164). The drive screw 77530 is rotatable about adrive axis DA in response to rotary motions generated by a motor of theclip applier 77500. The drive screw 77530 comprises a pair oflaterally-extending pins 77516 which extend away from the drive bar77511 of the actuator. The end effector 77520 comprise a first jaw 77522and a second jaw 77524 movable relative to each other between an openposition (FIG. 163) and a closed position (FIG. 164). The first jaw77522 and the second jaw 77524 at least partially define a receivingchamber 77521 between an inner surface 77518 of the first jaw 77522 andan inner surface 77519 of the second jaw 77524. The first jaw 77522 andthe second jaw 77524 are discussed in greater detail below.

The first jaw 77522 comprises a first cam member 77526. The second jaw77524 comprises a second cam member 77528. The first cam member 77526comprises a first pair of parallel slots 77527 that are angledtransverse to the drive axis DA. The second cam member 77528 comprises asecond pair of parallel slots 77529 that are angled transverse to thedrive axis DA. The first pair of parallel slots 77527 are transverse tothe second pair of parallel slots 77529. The laterally-extending pins77516 of the actuator 77510 are received in the first pair of parallelslots 77527 and the second pair of parallel slots 77529. In addition,the first cam member 77526 comprises a lateral slot 77523 located at theproximal end of the first cam member 77526. The second cam member 77528comprises a protrusion, or pin 77525, extending into the lateral slot77523 of the first cam member 77526. Operation of the clip applier 77500is discussed in greater detail below.

As discussed above, the rotation of the drive screw 77530 translates theactuator 77510. As the actuator 77510 translates from the proximalposition to the distal position, the laterally-extending pins 77516 willengage the sidewalls of the first pair of slots 77527 and the secondpair of slots 77529 to move the end effector from its open position toits closed position. Notably, the first jaw 77522 and the second jaw77524 close in a parallel manner. Stated another way, the first jaw77522 and the second jaw 77524 are translated closed, not rotatedclosed. This motion is controlled by the arrangement of thelaterally-extending pins 77516 and the pin 77525.

FIGS. 165 and 166 depict a clip applier 77600 in accordance with atleast one embodiment. The clip applier comprises a shaft 77640 extendingfrom a housing of the clip applier 77600. The shaft 77640 defines ashaft axis SA. The clip applier 77600 further comprises an end effector77620, an actuator 77650, and a drive screw 77660 extending proximallyfrom the actuator 77650. The actuator 77650 comprises a boss 77658 atits proximal end. The boss 77658 comprises an internal thread configuredto receive the drive screw 77660; thus, the drive screw 77660 isthreadably engaged with the actuator 77650. The actuator 77650 isrotatably constrained within the shaft 77640, such that, the actuator77650 is translated between a distal position (FIG. 165) and a proximalposition (FIG. 166) when the drive screw 77660 is rotated. The drivescrew 77660 is rotatable about the shaft axis SA in response to rotarymotions generated by a motor of the clip applier 77600.

Further to the above, the end effector 77620 comprise a first jaw 77622and a second jaw 77632 movable relative to each other between an openposition (FIG. 165) and a closed position (FIG. 166). The first jaw77622 and the second jaw 77632 at least partially define a receivingchamber 77621 between an inner surface 77623 of the first jaw 77622 andan inner surface 77633 of the second jaw 77632. The first jaw 77622comprises a first cam member 77624 extending proximally from the firstjaw 77622. The second jaw 77632 comprises a second cam member 77634extending proximally from the second jaw 77632. The first cam member77624 comprises a first slot 77626 that is angled transverse to theshaft axis SA. More specifically, the first slot 77626 comprises adistal portion extending in one direction and a proximal portionextending in another direction. The second cam member 77634 comprises asecond slot 77636 that is transverse to the shaft axis SA. Morespecifically, the second slot 77636 comprises a distal portion extendingin one direction and a proximal portion extending in another direction.The first slot and the second slot overlap to form an X-shape asillustrated in FIG. 165.

The actuator 77650 comprises a distal slot 77654, a proximal slot 77656,and a distal protrusion 77652. The distal slot 77654 is transverse tothe shaft axis SA in a first direction, and the proximal slot 77656 istransverse to the shaft axis SA in a second direction, opposite thefirst direction. The distal protrusion 77652 of the actuator 77650 isconfigured to be slidably received in the first slot 77626 and thesecond slot 77636. Further, the first cam member 77624 comprises a firstcam protrusion 77628 located at the proximal end of the first cam member77624. The second cam member 77634 comprises a second cam protrusion77638 located at the proximal end of the second cam member 77634. Thefirst cam protrusion 77628 is located proximal to the second camprotrusion 77638. The first cam protrusion 77628 is configured to beslidably received in the proximal slot 77656 of the actuator 77650 andthe second cam protrusion 77638 is configured to be slidably received inthe distal slot 77654 of the actuator 77650. Operation of the clipapplier 77600 is discussed in greater detail below.

As discussed above, the rotation of the drive screw 77660 results intranslation of the actuator 77650. As the actuator 77650 translates fromthe distal position (FIG. 165) to the proximal position (FIG. 166), thedistal protrusion 77652 of the actuator 77650 will move proximally adistance D1. As the distal protrusion 77652 moves proximally, the distalprotrusion 77652 engages the sidewalls of the first slot 77626 and thesecond slot 77636 which are moved toward each other. Further, as theactuator 77650 moves proximally, the distal slot 77654 and the proximalslot 77656 will move proximally resulting in the second cam protrusion77638 and the first cam protrusion 77628 moving transversely to theshaft axis SA in opposite directions. More specifically, the first camprotrusion 77628 will move distally along the shaft axis SA andtransverse to the shaft axis SA in a first direction FD. Further, thesecond cam protrusion 77638 will move distally along the shaft axis SAand transverse to the shaft axis SA in a second direction SD. As thefirst cam protrusion 77628 moves in the first direction FD and thesecond cam protrusion 77638 moves in the second direction SD, the firstjaw 77622 and the second jaw 77632 will move toward the closed positionillustrated in FIG. 166. More specifically, the distal end of the innersurface 77623 of the first jaw 77622 and the distal end of the innersurface 77633 of the second jaw 77632 will move toward each other. Thus,the inner surface 77623 of the first jaw 77622 and the inner surface77633 of the second jaw 77632 are not parallel when the first jaw 77622and the second jaw 77632 are in the closed position. In other words, theend effector 77620 has tip-first closure of the jaws as compared to theend effector 77520 which has parallel closure of the jaws.

FIGS. 167A-167D depict a clip applier 77700 in accordance with at leastone embodiment. The clip applier 77700 comprises an end effector 77720,a clip magazine 77710, a clip feeding system 77730, and a jaw camassembly 77740. The end effector 77720 comprises a pair of opposing jaws77721 configured to move between an open position and a closed position,as described herein. The clip magazine 77710 and the jaw cam assembly77740 are actuatable via two separate rotary inputs. The clip magazine77710 is similar to the clip magazine 76010 of the clip applier 76000(see FIG. 114). The clip magazine 77710 comprises a plurality of clips77714 stored in a plurality of clip holders 77718. The clip magazine77710 is rotatable and translatable via a magazine driver 77716 that isoperably responsive to a first rotary input 77712. The first rotaryinput 77712 is operably responsive to rotary motions generated within ahousing of the clip applier 77700. In any event, the clip magazine 77710is configured to be advanced and retracted to strip the clips 77714 fromthe clip magazine 77710 into a loading slot, such as loading slot 77722of end effector 77720.

The jaw cam assembly 77740 comprises a jaw cam 77742 that is threadablyengaged with a second rotary input 77744. The second rotary input 77744is operably responsive to rotary motions generated within the housing ofthe clip applier 77700. The second rotary input 77744 is configured totranslate the jaw cam 77742 between a fully-advanced position (FIG.167D), a retracted position (FIG. 167B), and a fully-retracted position(FIG. 167C). The jaw cam 77742 is configured to interact with theopposing jaws 77721 of the end effector 77720 to move the opposing jaws77721 between the open position and the closed position. Morespecifically, the jaw cam 77742 comprises a cam window 77743 (see FIG.168) configured to be receive over a proximal portion 77723 of theopposing jaws 77721. The first rotary input 77712 and the second rotaryinput 77744 are operable independently of one another by a motor controlsystem of the clip applier 777000.

When the jaw cam 77742 is in its fully-advanced position (FIG. 167D),the opposing jaws 77721 of the end effector 77720 are in their closedposition. More specifically, as the jaw cam 77742 moves toward thefully-advanced position the cam window 77743 of the jaw cam 77742 willcammingly engage the exterior of the opposing jaws 77721 to move theopposing jaws 77721 to the closed position. When the jaw cam 77742 is inits retracted position (FIG. 167B) or the fully-retracted position (FIG.167C), the opposing jaws 77721 are in their open position. The opposingjaws 77721 are biased away from each allowing the opposing jaws 77721 tomove to the open position when the jaw cam 77742 is not holding theopposing jaws 77721 together. The opposing jaws 77721 can be movedbetween the open and closed position without performing clip feed orclip magazine functions.

The above being said, the jaw cam 77742 is also used to release the clipfeeding system 77730 such that a clip is fed into the end effector77720. As described below, the jaw cam 77742 is retracted from itsretracted position to its fully-retracted position to release a feedershoe 77732 which is pushed distally by a feeder spring 77734.

Referring now to FIGS. 168 and 169, the jaw cam 77742 further comprisesa shoe release latch 77746 positioned thereon. The shoe release latch77746 is biased toward the jaw cam 77742 by a biasing member 77748. Theshoe release latch 77746 comprises a protrusion 77747 on its distal endthat extends through a top opening 77745 in the jaw cam 77742 and downinto the cam window 77743 of the jaw cam 77742. The protrusion 77747comprises a chamfered portion 77747 a on the distal end of the shoerelease latch 77746. The shoe release latch 77746 further comprises achamfered portion 77749 on its proximal end.

Further to the above, the clip feeding system 77730 comprises the feedershoe 77732, a release latch 77731, and the feeder spring 77734. In itsstored position, the feeder shoe 77732 is biased away from a proximalstop 77750 of the clip applier 77700 by the feeder spring 77734, butheld in place by the release latch 77731 (see FIG. 167A).

When the clip applier 77700 is in an initial position (e.g., when theclip applier 777000 is placed into a surgical site), the opposing jaws77721 of the end effector 77720 can be in the closed position (see FIG.167A). In such instances, the feeder shoe 77732 is held in its stored,or ready-to-be-fired position, as described above.

When the jaw cam 77742 is retracted to the retracted position (FIG.167B) to open the opposing jaws 77721, the loading slot 77722 canreceive one of the clips 77714 from the clip magazine 77710. The jaw cam77742 can then be retracted to the fully-retracted position (FIG. 167C)to release the feeder shoe 77732 and advance the clip 77714 into theopposing jaws 77721 of the end effector 77720. More specifically, as thejaw cam 77742 is retracted to the fully-retracted position (FIG. 167C),the jaw cam 77742 engages a front side 77738 of the release latch 77731to rotate the release latch 77731 away from the feeder shoe 77732.Further, as the jaw cam 77742 is moved to the fully-retracted position,the shoe release latch 77746 engages the proximal stop 77750 which movesthe shoe release latch 77746 in an upward direction UD (see FIG. 169)providing clearance for the feeder shoe 77732 to be advanced toward theend effector 77720.

After the clip 77714 has been advanced into the end effector 77720, thejaw cam 77742 is moved to its fully-advanced position (see FIG. 167D) tomove the opposing jaws 77721 of the end effector 77720 to their closedposition to crimp the clip 77714 positioned in the end effector 77720.Notably, the jaw cam 77742 carries the shoe release latch 77746 distallyto engage the feeder shoe 77732 once again. More specifically, as thejaw cam 77742 moves toward the fully-advanced position, the chamferedportion 77747 a on the distal end of the shoe release latch 77746engages the proximal end of the feeder shoe 77732 such that the shoerelease latch 77746 is biased in the upward direction UD. When the jawcam 77742 is in the fully-advanced position, the shoe release latch77746 moves downward toward the feeder shoe 77732 by the biasing member77748. In other words, as the jaw cam 77742 is moved toward thefully-advanced position, the shoe release latch 77746 can move up andover the feeder shoe 77732 to engage a distal side of the feeder shoe77732.

The jaw cam 77742 can now be used to retract the feeder shoe 77732. Thefeeder shoe 77732 is re-engaged with the release latch 77731 when thejaw cam 77742 reaches its retracted position (FIG. 167B).

When the feeder shoe 77732 is engaged with the release latch 77731, thejaw cam 77742 can translate freely between the retracted position FIG.167A and the fully-advanced position (FIG. 167D) to actuate the opposingjaws 77721 of the end effector 77720, as discussed herein. The opposingjaws 77721 can be opened and closed without having to feed and/or crimpa clip. Such opening and closing is often needed to position the endeffector of the clip applier within the patient. This is possible, inpart, owing to the fact that the clip feeding system isn't triggeredwithin the closing stroke of the jaw cam system. Rather, as describedabove, the clip feeding system is actuated only when the jaw cam isfully-retracted, i.e., retracted proximally behind the position of thejaw cam associated with the fully-open position of the opposing jaws.Once the jaw cam 77742 is moved to the retracted position (FIG. 167B),another clip 77714 can be positioned in the loading slot 77722 from theclip magazine 77710 and this clip 77714 can be advanced into the endeffector 77720 by the feeder shoe 77732 and crimped by the opposing jaws77721, as discussed above. This process can continue until all of theclips 77714 have been spent from the clip magazine 77710.

FIGS. 170-175 depict a clip applier 77800 in accordance with at leastone embodiment. The clip applier 77800 comprises an end effector 77820,a clip track 77840, a cam member 77850, a clip advancer 77860, and arotary input 77870. The rotary input 77870 defines a rotary axis RA andis rotatable about the rotary axis RA in response to rotary motionsgenerated by a motor within a housing of the clip applier 77800. Therotary input 77870 comprises a proximal threaded portion 77872 and adistal threaded portion 77874 extending from the proximal threadedportion 77872. The proximal threaded portion 77872 comprises a largerthread pitch than the distal threaded portion 77874; however, anysuitable thread pitches could be used.

The end effector 77820 extends distally from the clip track 77840 and ismounted to the clip track 77840 via a mounting member 77830. Themounting member 77830 extends above the clip track 77840 and in-betweena first jaw 77822 and a second jaw 77824 of the end effector 77820. Thefirst jaw 77822 and the second jaw 77824 are movable relative to eachother between an open position (FIGS. 172 and 175) and a closed position(FIGS. 170 and 173). The first jaw 77822 and the second jaw 77824 atleast partially define a receiving chamber 77826 there between. Further,the mounting member 77830 comprises a pair of laterally-extending pins77832. Each of the first jaw 77822 and the second jaw 77824 comprisesholes 77829 configured to slidably receive the pair oflaterally-extending pins 77832 of the mounting member 77830. Thus, thefirst jaw 77822 and the second jaw 77824 are movable laterally relativeto each other along the laterally-extending pins 77832.

The first jaw 77822 comprises a first pin 77827 extending upwardintermediate the holes 77829 in the first jaw 77822. Further, the secondjaw 77824 comprises a second pin 77828 extending upward intermediate theholes 77829 in the second jaw 77824. The first pin 77827 is slidablyreceived in a first slot 77852 of the cam member 77850, and the secondpin 77828 is slidably received in a second slot 77854 of the cam member77850. The first slot 77852 comprises a longitudinal portion 77856 and atransverse portion 77857. The longitudinal portion 77856 is parallel tothe rotary axis RA of the rotary input 77870 and the transverse portion77857 is transverse to the rotary axis RA of the rotary input 77870.Similarly, the second slot 77854 comprises a longitudinal portion 77858and a transverse portion 77859. The longitudinal portion 77858 isparallel to the rotary axis RA of the rotary input 77870 and thetransverse portion 77859 is transverse to the rotary axis RA of therotary input 77870. The transverse portions 77857 and 77859 extendtoward the rotary axis RA from the longitudinal portions 77856 and77858.

Further to the above, the cam member 77850 further comprises aprotrusion 77851 extending upward from its proximal end. The protrusion77851 comprises an internal thread 77853 (see FIG. 175) that isthreadably engaged with the distal thread portion 77874 of the rotaryinput 77870. Similarly, the clip advancer 77860 comprises a protrusion77862 extending upward from its proximal end. The protrusion 77862comprise an internal thread 77864 that is threadably engaged with theproximal threaded portion 77872 of the rotary input 77870. Both theprotrusion 77851 of the cam member 77850 and the protrusion 77862 of theclip advancer 77860 are rotatably constrained within a slot 77882 of atop housing 77880 of the clip applier 77800. The slot 77882 allows forthe cam member 77850 and the clip advancer 77860 to translate along therotary axis RA as the rotary input 77870 is rotated about the rotaryaxis RA. As discussed above, the proximal thread portion 77872 of therotary input 77870 comprises a larger thread pitch than the distalthread portion 77874 of the rotary input 77870. Thus, rotation of therotary input 77870 will translate the clip advancer 77860 through a clipadvancement stroke and will translate the cam member 77850 through a jawclosure stroke that is smaller than the clip advancement stroke. Inother words, rotation of the rotary input 77870 will translate the clipadvancer 77860 a greater distance than it will translate the cam member77850. The clip advancer 77860 further comprises a feeder shoe 77866extending downward from the clip advancer 77860. The feeder shoe 77866is configured to translate through a loading slot 77842 of the cliptrack 77840 as the clip advancer 77860 is translated via the rotaryinput 77870. The loading slot 77842 is configured to store a pluralityof clips 77804 in a longitudinal row for sequential advancement into thereceiving chamber 77826 of the end effector 77820. The operation of theclip applier 77800 is discussed in greater detail below.

In an initial position, the first jaw 77822 and the second jaw 77824 arein the closed position without a clip 77804 placed between them, suchinstances can occur, when the clip applier 77800 is first loaded into asurgical site. Also in such instances, both the clip advancer 77860 andthe cam member 77850 are in their proximal position (see FIGS. 170 and173), for example. When the rotary input 77870 is rotated in a firstdirection FD, the clip advancer 77860 and cam member 77850 translatedistally to intermediate positions to move the first jaw 77822 and thesecond jaw 77824 into the open position and to advance a clip 77804through the clip track 77840 to a position just proximal to thereceiving chamber 77826 of the end effector 77820. When the cam member77850 is translated distally from its proximal position to thisintermediate position (FIGS. 171 and 174), as described above, thetransverse portions 77857 and 77859 of the first and second slots 77852and 77854 of the cam member 77850 engage the first and second pins 77827and 77828 of first and second jaws 77822, 77824 and move the first andsecond pins 77827 and 77828 away from each other until the first andsecond pins 77827 and 77828 move into the longitudinal portions 77856and 77858 of the first and second slots 77852, 77854 (see FIG. 171).

As discussed above, the first and second pins 77827 and 77828 extendupward from the first and second jaws 77822 and 77824, and the first andsecond jaws 77822 and 77824 are slidable relative to each other alongthe pair of laterally-extending pins 77832 of the mounting member 77830.Thus, as the cam member 77850 is moved distally from its proximalposition to this intermediate position, the first jaw 77822 and thesecond jaw 77824 are moved to their open position. Further, the firstclip 77804 is advanced to a position just proximal to the receivingchamber 77826 by the feeder shoe 77866 of the clip advancer 77860 whenthe clip advancer 77860 is moved from its proximal position (FIG. 173)to this intermediate position (FIG. 174). In other words, the rotaryinput 77870 can be rotated in the first direction FD to move the firstand second jaws 77822 and 77824 to the open position without advancing aclip 77804 into the end effector 77820.

When the clip advancer 77860 and cam member 77850 are in theirintermediate positions (FIGS. 171 and 174), the rotary input 77870 canbe rotated further in the first direction FD to translate the clipadvancer 77860 and the cam member 77850 further distally to advance thefirst clip 77804 into the receiving chamber 77826 of the end effector77820. More specifically, the cam member 77850 can be moved from theintermediate position (FIG. 171) to a distal position (FIG. 172) and theclip advancer 77860 can be moved from the intermediate position (FIG.171) to a distal position (FIG. 172). As the cam member 77850 is movedtoward the distal position, the first and second pins 77827 and 77828 ofthe first and second jaw 77822 and 77824 will move through thelongitudinal portions 77856 and 77858 of the first and second slots77852 and 77854 of the cam member 77850 and the first and second jaws77822, 77824 are not driven laterally. As the clip advancer 77860 ismoved toward the distal position, the feeder shoe 77866 of the clipadvancer 77860 will advance the first clip 77804 into the receivingchamber 77826 defined between the first and second jaws 77822 and 77824.The feeder shoe 77866 is angled such that it will also advance thesecond clip 77804 distally to a position just proximal to the receivingchamber 77826.

Once the first clip 77804 has been advanced into the receiving chamber77826, the rotary input 77870 can be rotated in the second direction toretract the clip advancer 77860 and cam member 77850 to theirintermediate positions. When the clip advancer 77860 and cam member77850 are moved into their intermediate positions, the first and secondjaws 77822 and 77824 will remain in the open position and the feedershoe 77866 of the clip advancer 77860 is retracted proximally beyond thereceiving chamber 77826. Thus, the feeder shoe 77866 will not interferewith the crimping of the first clip 77804 positioned in the receivingchamber 77826.

Further to the above, the rotary input 77870 can be rotated furtherstill in the second direction to retract the clip advancer 77860 and cammember 77850 from their intermediate positions to their proximalpositions. When the clip advancer 77860 and cam member 77850 are movedtoward their proximal positions, the first and second jaws 77822 and77824 move to the closed position to crimp the first clip 77804positioned therebetween. Further, the clip advancer 77860 movesproximally such that the feeder shoe 77866 moves proximally beyond thesecond clip 77804 positioned in the clip track 77840 just proximal tothe receiving chamber 77826. The distal end of the feeder shoe 77866 isangled such that the feeder shoe 77866 can move up and over the secondclip 77804 into position behind the second clip 77804. The first andsecond jaws 77822 and 77824 can then be moved to the open position torelease the first clip 77804 from the first and second jaws 77822 and77824 while the second clip 77804 is advanced into the receiving chamber77826. The second clip 77804 can then be crimped and released while athird clip 77804 is advanced into the receiving chamber 77826, and soforth.

Referring to FIG. 176, a graph 78000 of the displacement of a crimpingdrive of a clip applier system at various set points over time isdepicted. The crimping drive is configured to crimp a clip 78004positioned in between the jaws of an end effector, as discussed herein.The crimping drive is operably responsive to a motor of the clip appliersystem configured to generate rotary motions. Further, the motor iscontrollable by a motor controller comprising a processor and a memoryin signal communication with the processor. The motor controller isconfigured to detect the current draw of the motor, compare the detectedcurrent to pre-determined ranges of current stored in the memory of themotor controller, and then adjust the speed and/or force of the crimpingdrive based on the detected current. The pre-determined ranges ofcurrent stored in the memory can be based on the expected amount ofcurrent draw on the motor for various clip formations. This informationcan be programmed into the motor controller when it is manufacturedand/or from a surgical hub, as described in greater detail below.

As the crimping drive is moved from distance δ₀ to distance δ_(A),referring still to FIG. 176, the clip 78004 positioned in the endeffector is configured to be crimped by the crimping drive such that thedistal ends of the legs of the clip touch at set point 78010. This typeof formation is called, tip first, however other types of formation canbe used. As the crimping drive is moved from distance δ_(A) to distanceδ_(B), the clip is further formed at set point 78020. As the crimpingdrive is moved from distance δ_(B) to distance δ_(C), the clip iscompletely formed at set point 78030. Each orientation of the clip 78004at set points 78010, 78020, and 78030 can be detected by the motorcontroller based on the current draw of the motor and/or any otherperformance characteristic of the motor. With this data, the motorcontroller can adapt the operation of the motor to achieve a desiredresult. For instance, when the ends of the legs of the clip 78004 touch(e.g., at set point 78010), the motor controller will likely detect anincrease in the current draw of the motor due to the force required toform the clip beyond the configuration shown at set point 78010. As theclip 78004 is further formed to the orientation depicted at set point78020, the current draw will likely increase further as the forcerequired to crimp the clip 78004 will increase further owing to theresistance of the tissue and the additional deformation of the clip78004. As the clip 78004 is fully formed (e.g., at point 78030), thecurrent draw of the motor will significantly increase as the clip 78004cannot be formed further. The current draw on the motor at each of theseset points 78010, 78020, 78030 can be compared to the pre-determinedranges of current stored in the memory of the motor controller todetermine how the motor controller is to proceed, as described ingreater detail below.

At set point 78010, further to the above, the motor controller candirect the motor to continue advancing the crimping drive from distanceδ_(A) to δ_(B) or δ_(C) to further form the clip. Additionally, themotor controller can direct the motor to dwell for a set period of timeat set point 78010 (e.g., from t_(A) to t_(x), for example) and theneither retract the crimping drive from distance δ_(A) to distance δ₀ torelease the clip 78004 or advance the crimping drive from distance δ_(A)to distance δ_(B) or distance δ_(C) to further crimp the clip 78004. Themotor controller can direct the motor to perform similar functions ateach set point 78010, 78020, and 78030. For example, at set point 78020,the motor controller can direct the motor to continue to advance thecrimping drive from distance δ_(B) to distance δ_(c) to further form theclip. Additionally, at set point 78020, the motor controller can directthe motor to dwell for a set period of time (e.g., from t_(b) to t_(D),for example) and then either retract the crimping drive from distanceδ_(B) to distance δ₀ to release the clip 78004 or advance the crimpingdrive from distance δ_(B) to distance δ_(C) to completely crimp the clip78004, for example.

The current draws expected at each of the set points 78010, 78020, 78030can be pre-programmed into the memory of the motor controller such thatthe motor controller will automatically stop the motor when the currentdraw on the motor is indicative of one of the set points 78010, 78020,78030. The motor controller can then require a manual input from theuser of the clip applier system in order to proceed. Thus, a user of theclip applier system can selectively determine how much to deform theclip 78004 and when to release the clip 78004 such that varying rangesof clip formation are possible depending on the pre-programmed setpoints 78010, 78020, 78030. Further, the motor controller can beconfigured to slow down the motor, pause the motor, or speed up themotor at each set point based on the manual input from the user. Morespecifically, once a set point 78010, 78020, 78030 is reached the motorwill be paused and/or stopped, the user can then select a slow motionbutton (e.g., some form of actuator, for example) on the clip applier todirect the motor controller to slowly advance the crimping drive fromone set point to another or the user can select a fast motion button, oractuator, to direct the motor controller to more quickly advance thecrimping drive.

In previous devices, the opening and closing of the jaws of a clipapplier resulted in a clip being automatically cycled, i.e., fed intothe jaws and then crimped. In many instances, such an arrangement issuitable; however, many instances can arise where cycling a clip resultsin the clip being dropped into the patient, or otherwise wasted. Forinstance, when the jaws are closed to insert the clip applier through atrocar and then re-opened inside the patient, a clip is crimped and thendropped into the patient when the jaws are opened. In many embodimentsdescribed herein, the clip feeding system and the jaw drive system of aclip applier are operated by separate and distinct drive systems. Insuch embodiments, the clip feeding system can be deactivated while thejaw drive system is cycled. Such an arrangement allows the jaws of theclip applier to be opened and closed, as many times as needed, toposition the clip applier in a patient without cycling a clip. Once theclip applier is suitably positioned in the patient, the clip feedingsystem can be re-activated such that the clip feeding system and the jawdrive system can be used to co-operatively apply clips to the patienttissue. In various embodiments, the clip applier includes an actuatorand/or control in communication with the control system of the clipapplier that deactivates the clip feeding system when actuated. Incertain embodiments, the actuator is re-actuated to re-activate the clipfeeding system or the clip applier comprises a separate actuator tore-activate the clip applier.

Further to the above, the jaws of a clip applier can be used to graspand/or dissect the patient's tissue. In such instances, the jaws can berepeatedly opened and closed. Deactivating the clip feeding system, asdescribed above, can facilitate an end effector being used in thismanner. In addition to or in lieu of the above, a clip applier can havea grasping and/or dissecting mode. In such a mode, or modes, thecontroller of the clip applier can move the jaws outside of their normalclosing and opening strokes. In a grasping mode, for instance, the jawscan be moved closer together than their fully-crimped, or fully-fired,position. In such a position, the jaws can be used to grasp very smallobjects, such as a suturing needle, for example. In a dissecting mode,for instance, the jaws can be moved further apart than their open, orready-to-fire, position. In such a position, the jaws can be used tospread open an otomy in the patient tissue. Similar to the above, theclip applier can include one or more actuators and/or controls which canbe used to place the clip applier in a grasping and/or dissecting mode,or modes by the clinician.

Notably, further to the above, the loads, or forces, experienced by thejaws of the clip applier, and/or patterns of forces experienced by thejaws of the clip applier, are detectably different by one or more straingauges and/or load cells, for example. For instance, the jaws of theclip applier may experience very little loading throughout the closingstroke of the jaws, or at least until the end of the closing stroke,when a clip is not positioned between the jaws and the jaws are beingused for grasping. The controller of the clip applier can identify sucha force pattern and automatically enter into the grasping mode. Asimilar pattern can occur when the jaws of the clip applier are beingused to dissect the tissue, except that the force suddenly increases asthe jaws are being opened. The controller of the clip applier canidentify such a force pattern and automatically enter into thedissecting mode. The clip applier can have an override feature which,when actuated by the clinician, can place the clip applier back into itsclip firing mode.

As described above, the control system of the clip applier ispre-programmed, or programmed prior to being used by the clinician, tomove the jaws of the clip applier to pre-determined positions. Invarious instances, the control system comprises an interface configuredto permit the clinician to set, or program, positions for the jaws. Suchan interface can include a control screen and/or actuators incommunication with the clip applier control system, for example. Thecontrol system comprises a memory, such as a solid state memory, forexample, configured to store these settings such that the jaws can beautomatically moved to these positions when directed to do so by theclinician. In at least one instance, the clip applier comprises a firstposition control and a second position control, but could include anysuitable number of position controls. For each position control, theclinician can program a specific position or configuration for the jawswhen the position control is actuated. Such positions can include a lessthan fully-open position and a less than fully-closed position, forexample.

Further to the above, the initial testing of a clip applier on amanufacturing line generates the expected load curve needed to fire aclip in that specific clip applier. The load curve can be used to form aset of thresholds that the device is expected to operate within, such asthe set points discussed above, for example. The motor current ismeasured as an indicator of load while closing the jaws while the motorvoltage is an indicator of motor speed. If, during use, the load on themotor exceeds the expected threshold (indicating higher loads and/orthicker tissue, for example), the closed loop nature of the systemallows the control algorithm stored in the memory of the motorcontroller to adjust the current supplied to the motor. These changes,however, are on-the-fly changes. They do not evaluate the loadsexperienced during other firings in that instrument, or in otherinstruments. That said, such data can be used to adapt the controlprogram of the clip applier. Such adjustments can comprise adjusting themotor voltage to slow down the advancement rate of the crimping driveand/or change the final stroke position of the crimping drive, forexample.

Situational awareness can be used to adjust operations of the clipapplier. Situational awareness is the ability of a surgical system todetermine or infer information related to a surgical procedure from datareceived from databases and/or instruments. The information can includethe type of procedure being undertaken, the type of tissue beingoperated on, or the body cavity that is the subject of the procedure.With the contextual information related to the surgical procedure, thesurgical system can, for example, improve the manner in which itcontrols an instrument and provide suggestions to the surgeon during thecourse of the surgical procedure. In various instances, the control ofthe surgical instrument can be adjusted without requiring input from theuser of the surgical instrument.

The clip appliers described herein, when used in conjunction with thesurgical hub and situational awareness modules as described hereinand/or incorporated by reference herein, can be utilized to detectdiseased tissue and/or detect tissue quality. For example, the clipappliers disclosed herein can detect an atherosclerosis (e.g., hardeningof the arteries) or aneurysms (e.g., weak artery walls), as well asdetect the presence of another clip, staple, or artificial objectcaptured between the jaws of the clip applier.

More specifically, a surgical hub or system, can detect the risk of apotential atherosclerosis (hardening of the arteries) by surveyingcontextual cues (e.g., pre-determined patient information and/or patientinformation gathered by the surgical system during the procedure, forexample) stored in the surgical hub that are indicative of such acondition, such as, high blood pressure, high cholesterol (especiallyLDL cholesterol), and co-morbidities (e.g., obesity and diabetes, forexample). If such conditions are detected, the surgical hub can directthe clip applier being used to respond in a specific manner. The firstaction to the contextual cues can include slowing down the jaw actuationrate, lowering the max torque and clamp load thresholds for non-firingoperations (e.g., opening and closing the jaws of the clip applierwithout a clip present, for example) and/or decrease the max stroke of acam member or crimping drive being used to form the clip, for example.Further contextual cues can be monitored by the surgical system and asecond action can be taken by the surgical system in response to themonitored contextual cues, as discussed in greater detail below.

Further to the above, the surgical system can monitor a contextual cuesuch as the force required to crimp the clip. For example, the irregularforce peaks outside of the anticipated forming events and associatedslopes can be detected by the surgical system and the surgical systemcan direct the clip applier to perform a second action. Morespecifically, when irregular force peaks are detected, the motor can bestopped and the force on the jaws can be monitored to monitor the tissuecreep. Further, if the tissue does not relax (e.g., the tissue creep isabnormal) then something irregular may be in between the jaws. Thesurgical system can then indicate a fault condition and request feedbackfrom the user to open the jaws of the clip applier to preventunintentionally clamping the unknown object. Further still, if tissuerelaxation (e.g., tissue creep) is detected but is outside of thepredefined anticipated range, the surgical system can adjust theadvancement rate of the crimping/closure drive with additional set stoppoints for further monitoring and move the jaws at a slower crimpingrate. In other words, the surgical system can pause the closing of thejaws to monitor the tissue creep and then determine how to proceed basedon the tissue creep detected, for example.

Further to the above, the surgical system can monitor a contextual cuesuch as the load on the crimping drive shaft of the clip applier, forexample. The crimping drive shaft can be outfitted with a strain gaugein order to determine the forces within the crimping drive shaft whenthe clip applier crimps a clip. Thus, the strain gauge can be used todetermine the forces being applied to the tissue by the clip applierjaws. The clip applier can be used in conjunction with a surgicalsystem, as discussed above, including a surgical grasper, for example.The surgical grasper is used to hold the target tissue and can stretchor relax the tissue depending on the load detected within the crimpingdrive shaft. For example, if the loading of the crimping drive shaftapproaches a threshold value this indicates that the tissue beinggrasped or clipped is too thick for a clip to be crimped around thetissue, the grasper of the surgical system will automatically move in anattempt to relieve the forces on the crimping drive shaft. Morespecifically, the grasper can move to stretch the tissue to thin thetissue between the jaws of the clip applier so that the clip can beproperly crimped around the tissue, for example. If automatic reliefefforts do not relieve the load, the actuation of the jaws of the clipapplier (e.g., via the crimping drive shaft, for example) can be slowedor stopped by the surgical system.

Further to the above, the surgical hub can detect an aneurysm (weakartery wall strength) by surveying contextual cues (e.g., pre-determinedpatient information and/or patient information gathered by the surgicalsystem during the procedure, for example) stored in the surgical hubthat are indicative of such a condition. For example, a vision system ofthe surgical system including one or more cameras can detect a bulge orchange in artery thickness in a clamping location relative to adjacentareas. In addition to or in lieu of the above, the impedance of tissuecan be monitored to determine if a fatty deposit within the artery wallexists, which may be a sign of a weak artery wall. Also, the clipapplier jaw loading can be monitored to determine if there is a suddencompliance of the tissue indicative of a weak artery wall. In suchinstances, the force required to crimp a clip around the tissue is lessthan expected. A action to the contextual cues can be taken in responseto the monitored parameters, which can include slowing down the jawactuation rate, lowering the max torque and clamp load thresholds fornon-firing operations, and/or decrease the max stroke of a cam member orcrimping drive that drives clip formation, for example.

Further to the above, the surgical system can initiate an inquiry to thesurgical hub databases for a list of known contributing factors for ananeurysm that the patient may exhibit prior to or during the surgicalprocedure. This information can be used by the surgical system todetermine if the cause of the irregularity during tissue clampingrequires a greater/different response. For example, the knowncontributing factors inquired by the surgical system may include highblood pressure, smoking, obesity, family history of atherosclerosis,bacterial activity, and/or polyarteritis nodosa (e.g., inflammation ofthe small and medium arteries)—which, if present, can cause thecontroller of the hub to assume that an aneurysm is present.

Further to the above, the surgical system can monitor the contextualcues to identify a potential issue such as a weakened artery wall, forexample. If the surgeon pauses to inspect the surgical site after thedetected weakness is presented to the user, the clip applier canautomatically slow the crimping rate of the clip. In other words, thesurgical system assumes that a hesitation by the surgeon indicates thatthe surgeon is being cautious due to the contextual cue presented; thus,the surgical system automatically responds by slowing down the crimpingrate of the clip to prevent unintended tissue damage if there is in factan artery wall weakness present.

Further to the above, the surgical hub can detect the presence ofanother clip, staple, or object within the jaws of the clip applier bysurveying contextual cues stored in the surgical hub that are indicativeof such a condition.

For instance, if a previous procedure used clips in the relevant bodycavity, the controller can assume that high force stresses and/orstrains are the result of a previous clip being captured in the endeffector. The contextual cues to monitor to determine if an undesiredobject is between the jaws when clamping can include the forces on theclip during clip formation. If the forces depict a spike with highmagnitude and very steep slope during clip formation, at a time aftertip contact, or during leg forming, this can be indicative of anirregular object within the clip applier jaws. Further, visual cues fromthe vision system, described herein, can indicate to the use that anirregular object, such as a staple or clip already positioned in thesurgical site may be in between the jaws of the clip applier. Thisinformation can be fed back to the surgical hub, and/or the clip applierdirectly, to direct the clip applier to perform specific actions inresponse to the detected information. For example, the clip applier jawscan be stopped and a visual alert can be provided to the clinician, thefinal stroke distance to form the clip can be shortened such that thefinal crimped clip is not fully crimped to avoid shearing the irregularobject, and/or the jaws can be closed at a very slow rate to minimizethe damage to the irregular object and surrounding tissue.

FIG. 177 is a logic diagram of a control system 75000 for use with anyof the various clip appliers described herein. The control system 75000comprises a control circuit. The control circuit includes amicrocontroller 75040 comprising a processor 75020 and a memory 75030.One or more sensors, such as sensor 75080, sensor 75090, sensor 71502,and sensor array 71940, for example, provide real time feedback to theprocessor 75020. The control system 75000 further comprises a motordriver 75050 configured to control an electric motor 75010 and atracking system 75060 configured to determine the position of one ormore longitudinally movable components in the clip applier, such asfiring member 70165 (FIG. 35A), crimping drive 70180 (FIG. 36), feedermember 70630 (FIG. 53), firing member 70640 (FIG. 53), and closure tube70620 (FIG. 53), for example. The tracking system 75060 is alsoconfigured to determine the position of one or more rotationalcomponents in the clip applier, such as the rotatable clip magazine70650 (FIG. 52), for example. The tracking system 75060 providesposition information to the processor 75020, which can be programmed orconfigured to, among other things, determine the position of therotatable clip magazine 70650 (FIG. 52), determine the position of thefiring member, feeder member, closure tube and/or crimping drive, aswell as determine the orientation of the jaws of the clip applier. Themotor driver 75050 may be an A3941 available from Allegro Microsystems,Inc., for example; however, other motor drivers may be readilysubstituted for use in the tracking system 75060. A detailed descriptionof an absolute positioning system is described in U.S. PatentApplication Publication No. 2017/0296213, entitled SYSTEMS AND METHODSFOR CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT, the entiredisclosure of which is hereby incorporated herein by reference.

The microcontroller 75040 may be any single core or multicore processorsuch as those known under the trade name ARM Cortex by TexasInstruments, for example. In at least one instance, the microcontroller75040 is a LM4F230H5QR ARM Cortex-M4F Processor Core, available fromTexas Instruments, for example, comprising on-chip memory of 256 KBsingle-cycle flash memory, or other non-volatile memory, up to 40 MHz, aprefetch buffer to improve performance above 40 MHz, a 32 KBsingle-cycle serial random access memory (SRAM), internal read-onlymemory (ROM) loaded with StellarisWare® software, 2 KB electricallyerasable programmable read-only memory (EEPROM), one or more pulse widthmodulation (PWM) modules and/or frequency modulation (FM) modules, oneor more quadrature encoder inputs (QEI) analog, one or more 12-bitAnalog-to-Digital Converters (ADC) with 12 analog input channels, forexample, details of which are available from the product datasheet.

In various instances, the microcontroller 75040 comprises a safetycontroller comprising two controller-based families such as TMS570 andRM4x known under the trade name Hercules ARM Cortex R4, also by TexasInstruments. The safety controller may be configured specifically forIEC 61508 and ISO 26262 safety critical applications, among others, toprovide advanced integrated safety features while delivering scalableperformance, connectivity, and memory options.

The microcontroller 75040 is programmed to perform various functionssuch as precisely controlling the speed and/or position of the firingmember, feeder member, crimping drive or closure tube of any of the clipappliers disclosed herein, for example. The microcontroller 75040 isalso programmed to precisely control the rotational speed and positionof the end effector of the clip applier and the articulation speed andposition of the end effector of the clip applier. In various instances,the microcontroller 75040 computes a response in the software of themicrocontroller 75040. The computed response is compared to a measuredresponse of the actual system to obtain an “observed” response, which isused for actual feedback decisions. The observed response is afavorable, tuned, value that balances the smooth, continuous nature ofthe simulated response with the measured response, which can detectoutside influences on the system.

The motor 75010 is controlled by the motor driver 75050. In variousforms, the motor 75010 is a DC brushed driving motor having a maximumrotational speed of approximately 25,000 RPM, for example. In otherarrangements, the motor 75010 includes a brushless motor, a cordlessmotor, a synchronous motor, a stepper motor, or any other suitableelectric motor. The motor driver 75050 may comprise an H-bridge drivercomprising field-effect transistors (FETs), for example. The motordriver 75050 may be an A3941 available from Allegro Microsystems, Inc.,for example. The A3941 motor driver 75050 is a full-bridge controllerfor use with external N-channel power metal oxide semiconductor fieldeffect transistors (MOSFETs) specifically designed for inductive loads,such as brush DC motors. In various instances, the motor driver 75050comprises a unique charge pump regulator provides full (>10 V) gatedrive for battery voltages down to 7 V and allows the A3941 motor driver75050 to operate with a reduced gate drive, down to 5.5 V. A bootstrapcapacitor may be employed to provide the above-battery supply voltagerequired for N-channel MOSFETs. An internal charge pump for thehigh-side drive allows DC (100% duty cycle) operation. The full bridgecan be driven in fast or slow decay modes using diode or synchronousrectification. In the slow decay mode, current recirculation can bethrough the high-side or the lowside FETs. The power FETs are protectedfrom shoot-through by resistor adjustable dead time. Integrateddiagnostics provide indication of undervoltage, overtemperature, andpower bridge faults, and can be configured to protect the power MOSFETsunder most short circuit conditions. Other motor drivers may be readilysubstituted.

The tracking system 75060 comprises a controlled motor drive circuitarrangement comprising one or more position sensors, such as the sensor75080, sensor 75090, sensor 71502, and sensor array 71940, for example.The position sensors for an absolute positioning system provide a uniqueposition signal corresponding to the location of a displacement member.As used herein, the term displacement member is used generically torefer to any movable member of any of the clip appliers disclosedherein. In various instances, the displacement member may be coupled toany position sensor suitable for measuring linear displacement orrotational displacement. Linear displacement sensors may include contactor non-contact displacement sensors. The displacement sensors maycomprise linear variable differential transformers (LVDT), differentialvariable reluctance transducers (DVRT), a slide potentiometer, amagnetic sensing system comprising a movable magnet and a series oflinearly arranged Hall Effect sensors similar to the arrangementillustrated in FIG. 75, a magnetic sensing system comprising a fixedmagnet and a series of movable linearly arranged Hall Effect sensorssimilar to the arrangement illustrated in FIGS. 81A and 81B, an opticalsensing system comprising a movable light source and a series oflinearly arranged photo diodes or photo detectors, or an optical sensingsystem comprising a fixed light source and a series of movable linearlyarranged photo diodes or photo detectors, or any combination thereof.

The position sensors 75080, 75090, 71502, and 71940 for example, maycomprise any number of magnetic sensing elements, such as, for example,magnetic sensors classified according to whether they measure the totalmagnetic field or the vector components of the magnetic field. Thetechniques used to produce both types of magnetic sensors encompass manyaspects of physics and electronics. The technologies used for magneticfield sensing include search coil, fluxgate, optically pumped, nuclearprecession, SQUID, Hall-Effect, anisotropic magnetoresistance, giantmagnetoresistance, magnetic tunnel junctions, giant magnetoimpedance,magnetostrictive/piezoelectric composites, magnetodiode,magnetotransistor, fiber optic, magnetooptic, and microelectromechanicalsystems-based magnetic sensors, among others.

In various instances, one or more of the position sensors of thetracking system 75060 comprise a magnetic rotary absolute positioningsystem. Such position sensors may be implemented as an AS5055EQFTsingle-chip magnetic rotary position sensor available from AustriaMicrosystems, AG and can be interfaced with the controller 75040 toprovide an absolute positioning system. In certain instances, a positionsensor comprises a low-voltage and low-power component and includes fourHall-Effect elements in an area of the position sensor that is locatedadjacent a magnet. A high resolution ADC and a smart power managementcontroller are also provided on the chip. A CORDIC processor (forCoordinate Rotation Digital Computer), also known as the digit-by-digitmethod and Volder's algorithm, is provided to implement a simple andefficient algorithm to calculate hyperbolic and trigonometric functionsthat require only addition, subtraction, bitshift, and table lookupoperations. The angle position, alarm bits, and magnetic fieldinformation are transmitted over a standard serial communicationinterface such as an SPI interface to the controller 75040. The positionsensors can provide 12 or 14 bits of resolution, for example. Theposition sensors can be an AS5055 chip provided in a small QFN 16-pin4×4×0.85 mm package, for example.

The tracking system 75060 may comprise and/or be programmed to implementa feedback controller, such as a PID, state feedback, and adaptivecontroller. A power source converts the signal from the feedbackcontroller into a physical input to the system, in this case voltage.Other examples include pulse width modulation (PWM) and/or frequencymodulation (FM) of the voltage, current, and force. Other sensor(s) maybe provided to measure physical parameters of the physical system inaddition to position. In various instances, the other sensor(s) caninclude sensor arrangements such as those described in U.S. Pat. No.9,345,481, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM,which is hereby incorporated herein by reference in its entirety; U.S.Patent Application Publication No. 2014/0263552, entitled STAPLECARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, which is hereby incorporatedherein by reference in its entirety; and U.S. patent application Ser.No. 15/628,175, entitled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTORVELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT, which is herebyincorporated herein by reference in its entirety. In a digital signalprocessing system, absolute positioning system is coupled to a digitaldata acquisition system where the output of the absolute positioningsystem will have finite resolution and sampling frequency. The absolutepositioning system may comprise a compare and combine circuit to combinea computed response with a measured response using algorithms such asweighted average and theoretical control loop that drives the computedresponse towards the measured response. The computed response of thephysical system takes into account properties like mass, inertial,viscous friction, inductance resistance, etc., to predict what thestates and outputs of the physical system will be by knowing the input.

The absolute positioning system provides an absolute position of thedisplacement member upon power up of the instrument without retractingor advancing the displacement member to a reset (zero or home) positionas may be required with conventional rotary encoders that merely countthe number of steps forwards or backwards that the motor 75010 has takento infer the position of a device actuator, a firing member, a feederdrive, a crimping drive, a closure tube, and the like.

A sensor 75080 comprising a strain gauge or a micro-strain gauge, forexample, is configured to measure one or more parameters of the endeffector of the clip applier, such as, for example, the strainexperienced by the jaws during a crimping operation. In one embodiment,the sensor 75080 can comprise the strain gauges 71720 and 71730 (FIG.79) discussed in greater detail above, for example. The measured strainis converted to a digital signal and provided to the processor 75020. Inaddition to or in lieu of the sensor 75080, a sensor 75090 comprising aload sensor, for example, can measure the closure force applied by theclosure drive system to the jaws of the clip applier. In variousinstances, a current sensor 75070 can be employed to measure the currentdrawn by the motor 75010. The force required to clamp the first andsecond jaws to crimp a clip can correspond to the current drawn by themotor 75010, for example. The measured force is converted to a digitalsignal and provided to the processor 75020. A magnetic field sensor canbe employed to measure the thickness of the captured tissue. Themeasurement of the magnetic field sensor can also be converted to adigital signal and provided to the processor 75020.

The measurements of the tissue compression, the tissue thickness, and/orthe force required to close the end effector and crimp a clip aroundtissue as measured by the sensors can be used by the controller 75040 tocharacterize the position and/or speed of the movable member beingtracked. In at least one instance, the memory 75030 may store atechnique, an equation, and/or a look-up table which can be employed bythe controller 75040 in the assessment. In various instances, thecontroller 75040 can provide the user of the clip applier with a choiceas to the manner in which the clip applier should be operated. To thisend, a display 75044 can display a variety of operating conditions ofthe clip applier and can include touch screen functionality for datainput. Moreover, information displayed on the display 75044 may beoverlaid with images acquired via the imaging modules of one or moreendoscopes and/or one or more additional surgical instruments usedduring the surgical procedure.

As discussed above, the clip appliers disclosed herein may comprisecontrol systems. Each of the control systems can comprise a circuitboard having one or more processors and/or memory devices. Among otherthings, the control systems are configured to store sensor data, forexample. They are also configured to store data which identifies thetype of clip applier attached to a handle or housing, such as handle 700(FIG. 29), for example. More specifically, the type of clip applier canbe identified when attached to the handle or housing by the sensors andthe sensor data can be stored in the control system. Moreover, they arealso configured to store data including whether or not the clip applierhas been previously used and/or how many clips have been ejected fromthe clip magazine or clip cartridge of the clip applier duringoperation. This information can be obtained by the control system toassess whether or not the clip applier is suitable for use and/or hasbeen used less than a predetermined number of times, for example.

The surgical instrument systems described herein are motivated by anelectric motor; however, the surgical instrument systems describedherein can be motivated in any suitable manner. In certain instances,the motors disclosed herein may comprise a portion or portions of arobotically controlled system. U.S. patent application Ser. No.13/118,241, entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLEDEPLOYMENT ARRANGEMENTS, now U.S. Pat. No. 9,072,535, for example,discloses several examples of a robotic surgical instrument system ingreater detail, the entire disclosure of which is incorporated byreference herein.

EXAMPLES

Various aspects of the subject matter disclosed herein are set out inthe following example sets.

Example Set 1 Example 1

A surgical device for clipping tissue. The surgical device comprises ahousing, a shaft extending from the housing, and a first reloadreleasably attachable to the shaft. The first reload comprises a firstend effector and a first clip magazine including a plurality of firstclips. The surgical device further comprises a second reload releasablyattachable to the shaft when the first reload is not attached to theshaft. The first reload and the second reload are different sizes. Thesecond reload comprises a second end effector and a second clip magazineincluding a plurality of second clips.

Example 2

The surgical device of Example 1, wherein the first clips and the secondclips are different sizes.

Example 3

The surgical device of Examples 1 or 2, wherein the shaft comprises aproximal portion and a distal portion, and wherein the surgical devicefurther comprises an articulation joint connecting the proximal portionand the distal portion.

Example 4

The surgical device of Examples 1, 2, or 3, further comprising a motorconfigured to output rotary motions and a firing drive operablyresponsive to the rotary motions, wherein the firing drive is operablyconnected to a first driver of the first reload when the first reload isattached to the shaft, and wherein the firing drive is operablyconnected to a second driver of the second reload when the second reloadis attached to the shaft.

Example 5

The surgical device of Example 4, wherein the first driver is configuredto translate through a first driver stroke in response to a rotation ofthe firing drive when the first reload is attached to the shaft, whereinthe second driver is configured to translate through a second driverstroke in response to the rotation of the firing drive when the secondreload is attached to the shaft, and wherein the first driver stroke andthe second driver stroke are different lengths.

Example 6

The surgical device of Example 5, wherein the first driver is configuredto advance a first clip from the first clip magazine into the first endeffector during the first driver stroke, and wherein the second driveris configured to advance a second clip from the second clip magazineinto the second end effector during the second driver stroke.

Example 7

The surgical device of Example 5, wherein the first end effectorcomprises a first jaw and a second jaw movable relative to each otherbetween an open position and a closed position, and wherein the secondend effector comprises a first jaw and a second jaw movable relative toeach other between an open position and a closed position.

Example 8

The surgical device of Example 7, wherein the first driver is configuredto move the first jaw and the second jaw of the first end effectortoward the closed position during the first driver stroke, and whereinthe second driver is configured to move the first jaw and the second jawof the second end effector toward the closed position during the seconddriver stroke.

Example 9

The surgical device of Example 5, wherein the first reload comprises afirst drive screw threadably engaged with the first driver, wherein thefirst drive screw is operably connected to the firing drive when thefirst reload is attached to the shaft, wherein the second reloadcomprises a second drive screw threadably engaged with the seconddriver, wherein the second driver is operably connected to the firingdrive when the second reload is attached to the shaft, wherein the firstdrive screw comprises a first thread pitch, and wherein the second drivescrew comprises a second thread pitch that is different than the firstthread pitch.

Example 10

A surgical device for clipping tissue. The surgical device comprises ahousing, a shaft extending from the housing, and a first reloadcomprising a magazine of first clips. The first reload is releasablyattachable to the shaft. The surgical device further comprises a secondreload comprising a magazine of second clips. The second reload isreleasably attachable to the shaft when the first reload is not attachedto the shaft. The magazine of first clips and the magazine of secondclips are different sizes. The surgical device further comprises an endeffector extending from the shaft. The end effector comprises a firstjaw and a second jaw. The first jaw and the second jaw are movablerelative to each other between an open position and a closed position.The end effector further comprises a receiving portion at leastpartially defined between the first jaw and the second jaw.

Example 11

The surgical device of Example 10, wherein the magazine of second clipsis larger than the magazine of first clips.

Example 12

The surgical device of Examples 10 or 11, wherein each first clip of themagazine of first clips and each second clip of the magazine of secondclips are different sizes.

Example 13

The surgical device of Examples 10, 11, or 12, wherein the shaftcomprises a proximal portion and a distal portion, wherein the endeffector extends from the distal portion, and wherein the surgicaldevice further comprises an articulation joint configured to connect theproximal portion and the distal portion.

Example 14

The surgical device of Examples 10, 11, 12, or 13, further comprising amotor configured to output rotary motions and a firing drive operablyresponsive to the rotary motions, wherein the firing drive is operablyconnected to a first driver of the first reload when the first reload isattached to the shaft, and wherein the firing drive is operablyconnected to a second driver of the second reload when the second reloadis attached to the shaft.

Example 15

The surgical device of Example 14, wherein the first driver isconfigured to translate through a first driver stroke in response to arotation of the firing drive when the first reload is attached to theshaft, wherein the second driver is configured to translate through asecond driver stroke in response to the rotation of the firing drivewhen the second reload is attached to the shaft, and wherein the firstdriver stroke and the second driver stroke are different.

Example 16

The surgical device of Example 15, wherein a clip from the magazine offirst clips is advanced into the receiving portion of the end effectorduring the first driver stroke, and wherein a clip from the magazine ofsecond clips is advanced into the receiving portion of the end effectorduring the second driver stroke.

Example 17

The surgical device of Example 15, wherein the first jaw and the secondjaw are moved toward the closed position during the first driver stroke,and wherein the first jaw and the second jaw are moved toward the closedposition during the second driver stroke.

Example 18

A surgical device for clipping tissue. The surgical device comprises ahousing, a shaft extending from the housing and defining a shaft axis,an end effector extending from the shaft. The end effector comprises areceiver. The surgical device further comprises a rotary clip magazineconfigured to rotate about the shaft axis between a plurality of feedingpositions. The rotary clip magazine comprises a plurality of clipstorage chambers corresponding to the plurality of feeding positions.Each clip storage chamber removably stores a first clip comprising afirst central axis, and a second clip comprising a second central axis.The second clip is stacked on top of the first clip. The first centralaxis is radially and circumferentially offset from the second centralaxis.

Example 19

The surgical device of Example 18, wherein each clip storage chambercomprises an angled slot configured to hold the first clip and thesecond clip in the rotary clip magazine such that the first central axisof the first clip is radially and circumferentially offset from thesecond central axis of the second clip.

Example 20

The surgical device of Example 19, wherein each angled slot comprises aplurality of discrete holding locations configured to hold the firstclip and the second clip.

Example 21

The surgical device of Examples 18, 19, or 20, wherein the rotary clipmagazine further comprises an opening positioned between the pluralityof clip storage chambers, and wherein the opening is configured toreceive a rotary input extending from the housing.

Example Set 2 Example 1

A surgical device for clipping tissue. The surgical device comprises ahousing, a shaft extending from the housing and defining a shaft axis,an end effector extending from the shaft, a motor, a rotary inputconfigured to rotate in response to the motor, and a clip magazinecomprising a plurality of clips. The clip magazine is operably connectedto the rotary input. The clip magazine is movable in a first directionthrough a clip feed stroke in response to the rotation of the rotaryinput. The clip magazine is movable in a second direction in response tothe rotation of the rotary input. The second direction is transverse tothe first direction.

Example 2

The surgical device of Example 1, wherein the first direction istranslation along the shaft axis, and wherein the second direction isrotation about the shaft axis.

Example 3

The surgical device of Examples 1 or 2, wherein the end effectorcomprises a loading portion configured to receive a clip from the clipmagazine, a receiving portion, and a firing drive configured to advancea clip from the loading portion into the receiving portion.

Example 4

The surgical device of Example 3, wherein the plurality of clips arebiased outward relative to the shaft axis, and wherein, as the clipmagazine is rotated about the shaft axis, a dip is biased into theloading portion when the clip and the loading portion are aligned.

Example 5

The surgical device of Example 4, wherein, when the clip is positionedin the loading portion, the clip magazine is prevented from rotating.

Example 6

The surgical device of Example 5, wherein, after the clip in the loadingportion is advanced into the receiving portion, the clip magazine isrotatable by the rotary input to align another clip with the loadingportion to bias another clip into the loading portion.

Example 7

The surgical device of Examples 1, 2, 3, 4, 5, or 6, wherein the clipmagazine comprises at least two storage locations for the plurality ofclips, and wherein each storage location comprises at least two clips ina clip stack.

Example 8

The surgical device of Examples 1, 2, 3, 4, 5, 6, or 7, wherein a firstamount of rotation of the rotary input moves the clip magazine in thefirst direction, and wherein a second amount of rotation of the rotaryinput moves the clip magazine in the second direction.

Example 9

A surgical device for clipping tissue. The surgical device comprises ahousing and a shaft extending from the housing. The housing comprises amotor. The shaft defines a shaft axis and comprises a loading portion.The surgical device further comprises an end effector extending from theshaft, a rotary input, and a clip magazine. The rotary input isconfigured to rotate in response to the motor. The rotary inputcomprises a first cam lobe. The clip magazine comprises a plurality ofclips and a second cam lobe. The first cam lobe is configured to engagethe second cam lobe to translate the clip magazine from afully-retracted position to a fully-advanced position in response torotation of the rotary input in a first direction. A first clip from theclip magazine is aligned with the loading portion of the shaft when theclip magazine is in the fully-advanced position.

Example 10

The surgical device of Example 9, wherein the first clip is strippedfrom the clip magazine into the loading portion as the clip magazine isretracted from the fully-advanced position to the fully-retractedposition in response to rotation of the rotary input in a seconddirection opposite the first direction.

Example 11

The surgical device of Example 10, wherein the clip magazine is biasedtoward the rotary input via a biasing member, and wherein the biasingmember retracts the clip magazine toward the fully-retracted positionwhen the rotary input is rotated in the second direction.

Example 12

The surgical device of Examples 9, 10, or 11, wherein the rotary inputfurther comprises a notch at a distal end of the first cam lobe, whereinthe clip magazine further comprises a protrusion extending proximallyfrom the second cam lobe, and wherein the protrusion is configured toengage the notch when the clip magazine is in the fully-advancedposition.

Example 13

The surgical device of Example 12, wherein the rotary input and the clipmagazine rotate together when the protrusion of the clip magazine isengaged with the notch of the rotary input and the rotary input isrotated in the first direction.

Example 14

The surgical device of Examples 12 or 13, wherein the clip magazine isrotatable relative to the shaft axis to align another clip with theloading portion of the end effector when the protrusion of the clipmagazine is engaged with the notch of the rotary input.

Example 15

The surgical device of Examples 9, 10, 11, 12, 13, or 14, wherein theclip magazine comprises at least two storage locations for the pluralityof clips, and wherein each storage location comprises at least two clipsstacked on top of each other.

Example 16

The surgical device of Examples 9, 10, 11, 12, 13, 14, or 15, furthercomprising an articulation joint configured to permit articulation ofthe end effector relative to the shaft.

Example 17

A surgical device for clipping tissue. The surgical device comprises ahousing and a shaft extending from the housing. The housing comprises amotor configured to output rotary motions. The shaft defines a shaftaxis. The surgical device further comprises an end effector extendingfrom the shaft and a magazine comprising a plurality of clips. Themagazine is movable in a first direction in response to the rotarymotions. The magazine is movable in a second direction in response tothe rotary motions. The second direction is transverse to the firstdirection.

Example 18

The surgical device of Example 17, wherein the first direction istranslation along the shaft axis, and wherein the second direction isrotation about the shaft axis.

Example 19

The surgical device of Examples 17 or 18, further comprising a rotaryinput operably responsive to the rotary motions, wherein the rotaryinput is configured to transmit the rotary motions from the motor to themagazine to move the magazine in the first direction and the seconddirection.

Example 20

The surgical device of Example 19, wherein a first amount of rotation ofthe rotary input moves the magazine in the first direction, and whereina second amount of rotation of the rotary input moves the magazine inthe second direction.

Example Set 3 Example 1

A surgical device for clipping tissue. The surgical device comprises ahousing, a shaft extending from the housing, an end effector extendingfrom the shaft, a feeder drive, and a clip magazine. The shaft comprisesa loading chamber and defines a shaft axis. The end effector comprises areceiver. The feeder drive is configured to translate relative to theshaft through a plurality of feeding strokes. The clip magazine isattachable to the shaft. The clip magazine comprises a plurality ofclips stored therein. The clip magazine is configured to rotate aboutthe shaft axis between a plurality of positions. The plurality ofpositions comprises a plurality of loading positions and a plurality ofneutral positions. A clip is biased from the clip magazine into theloading chamber when the clip magazine is in a loading position. None ofthe plurality of clips can be biased from the clip magazine into theloading chamber when the clip magazine is in a neutral position. A clippositioned in the loading chamber can be advanced into the receiver ofthe end effector by the feeder drive during a feeding stroke. Thefeeding stroke can only be performed when the clip magazine is in aneutral position.

Example 2

The surgical device of Example 1, wherein the clip magazine furthercomprises biasing members, and wherein each clip in the clip magazine isbiased away from the shaft axis by a biasing member.

Example 3

The surgical device of Example 2, wherein the amount of force applied bythe biasing member to a clip when the clip magazine is in a loadingposition is greater than the amount of force applied by the biasingmember to a clip when the clip magazine is in a neutral position.

Example 4

The surgical device of Examples 2 or 3, wherein a biasing member isconfigured to occupy the loading chamber after all of the clips in theclip magazine have been spent to prevent rotation of the clip magazine.

Example 5

The surgical device of Examples 1, 2, 3, or 4, wherein the clip magazineis configured to support the feeder drive during a feeding stroke whenthe clip magazine is in a neutral position.

Example 6

The surgical device of Examples 1, 2, 3, 4, or 5, further comprising alockout configured to prevent rotation of the clip magazine after all ofthe clips in the clip magazine have been spent.

Example 7

The surgical device of Example 6, wherein the lockout comprises alockout clip stored in the clip magazine, and wherein the lockout clipprevents rotation of the clip magazine when the lockout clip is biasedinto the loading chamber.

Example 8

A surgical device for clipping tissue. The surgical device comprises ahousing, a shaft extending from the housing and defining a shaft axis,an end effector extending from the shaft, a feeder drive, and a clipmagazine attachable to the shaft. The end effector comprises a receiver.The feeder drive is configured to translate relative to the surgicaldevice through a plurality of feeding strokes. The clip magazinecomprises an outer tube and a carriage contained within the outer tube.The outer tube comprises a loading chamber. The carriage comprises aplurality of clips stored therein. The carriage is configured to rotaterelative to the outer tube about the shaft axis between a plurality ofpositions. The plurality of positions comprises a plurality of loadingpositions and a plurality of neutral positions. A clip is biased fromthe carriage into the loading chamber when the carriage is in a loadingposition. None of the plurality of clips can be biased from the carriageinto the loading chamber when the carriage is in a neutral position. Aclip positioned in the loading chamber can be advanced into the receiverof the end effector by the feeder drive during a feeding stroke.

Example 9

The surgical device of Example 8, wherein a feeding stroke can only beperformed when the clip magazine is in a neutral position.

Example 10

The surgical device of Examples 8 or 9, wherein each loading position islocated 120 degrees apart, wherein each neutral position is located 120degrees apart, and wherein the loading positions and the neutralpositions are located 60 degrees apart.

Example 11

The surgical device of Examples 8, 9, or 10, wherein the carriage isconfigured to support the feeder drive during a feeding stroke when thecarriage is in a neutral position.

Example 12

The surgical device of Examples 8, 9, 10, or 11, wherein the clipmagazine further comprises a plurality of biasing members, and whereineach clip in the carriage is biased away from the shaft axis by abiasing member.

Example 13

The surgical device of Example 12, wherein the amount of force appliedby the biasing member to a clip when the carriage is in a loadingposition is greater than the amount of force applied by the biasingmember to a clip when the carriage is in a neutral position.

Example 14

The surgical device of Examples 12 or 13, wherein a biasing member isconfigured to occupy the loading chamber after all of the clips in thecarriage have been spent to prevent rotation of the carriage relative tothe outer tube.

Example 15

The surgical device of Examples 8, 9, 10, or 11, wherein the carriagefurther comprises a lockout configured to occupy the loading chamberafter all of the clips in the carriage have been spent, and wherein thelockout prevents rotation of the carriage relative to the outer tubewhen the lockout is positioned in the loading chamber.

Example 16

The surgical device of Example 15, wherein the lockout comprises alockout clip stored in the carriage, and wherein the lockout clip islarger than the clips and prevents rotation of the carriage relative tothe outer tube when the lockout clip is positioned in the loadingchamber.

Example 17

A surgical device for clipping tissue. The surgical device comprises ahousing, a shaft extending from the housing, an end effector extendingfrom the shaft, a feeder drive, and a rotatable clip magazine attachableto the shaft. The shaft defines a shaft axis and comprises a loadingchamber. The feeder drive is configured to translate relative to thesurgical device. The rotatable clip magazine is configured to rotateabout the shaft axis between a plurality of positions. The clip magazinecomprises a plurality of clips stored therein. The plurality ofpositions comprises a loading position wherein a clip is biased from theclip magazine into the loading chamber when the clip magazine is in theloading position, and a neutral position, wherein none of the clips canbe biased from the clip magazine into the loading chamber and a clippositioned in the loading chamber can be advanced into the end effectorby the feeder drive when the clip magazine is in the neutral position.

Example 18

The surgical device of Example 17, wherein each clip in the clipmagazine is biased away from the shaft axis by a biasing member.

Example 19

The surgical device of Example 18, wherein the amount of force appliedby the biasing member to a clip when the clip magazine is in the loadingposition is greater than the amount of force applied by the biasingmember to a clip when the clip magazine is in the neutral position.

Example 20

The surgical device of Examples 17, 18, or 19, wherein the clip magazinefurther comprises a lockout configured to prevent rotation of the clipmagazine about the shaft axis after all of the clips in the clipmagazine have been spent.

Example 21

A surgical device comprising a housing, a shaft extending from thehousing and defining a shaft axis, an end effector extending from theshaft, a feeder drive, a rotatable clip magazine, and a rotary input.The shaft comprises a feeding chamber. The feeder drive is configured tomove between a proximal position and a distal position relative to theshaft. The rotatable clip magazine is configured to rotate about theshaft axis. The rotary input is selectively engageable with the feederdrive and the rotatable clip magazine. The rotary input is configured tobe engaged with the feeder drive and the rotatable clip magazine toconsecutively feed a clip from and deliver a clip to the feedingchamber.

Example Set 4 Example 1

A surgical device for clipping tissue. The surgical device comprises ahousing, a shaft extending from the housing and defining a shaft axis,and an end effector extending from the shaft. The end effector comprisesa first jaw, a second jaw, and a receiver at least partially definedbetween the first jaw and the second jaw. The first jaw and the secondjaw are movable relative to each other between an open position and aclosed position. The surgical device further comprises a rotatable clipmagazine, a first advancing system, and a second advancing system. Therotatable clip magazine is configured to rotate about the shaft axis.The clip magazine is configured to store at least two clips. The secondadvancing system is configured to operate sequentially with the firstadvancing system. The first advancing system and the second advancingsystem are configured to sequentially advance the clips into thereceiver of the end effector.

Example 2

The surgical device of Example 1, wherein the first advancing system isconfigured to advance a clip from a feeding position adjacent therotatable clip magazine into a firing position located distal to thefeeding position, and wherein the second advancing system is configuredto advance the clip in the firing position into the receiver of the endeffector.

Example 3

The surgical device of Examples 1 or 2, wherein the first advancingsystem is driven by a first input and the second advancing system isdriven by a second input.

Example 4

The surgical device of Examples 1, 2, or 3, wherein the first jaw andthe second jaw are biased away from each other toward the open position,wherein the second advancing system comprises a cam member positionedaround the first jaw and the second jaw, wherein the cam member isconfigured to translate relative to the end effector between a proximalposition, an intermediate position, and a distal position, and whereinthe intermediate position is located between the proximal position andthe distal position.

Example 5

The surgical device of Example 4, wherein the first jaw and the secondjaw are in the open position when the cam member is in the proximalposition and the intermediate position, and wherein the first jaw andthe second jaw are moved toward the closed position when the cam membermoves from the intermediate position to the distal position.

Example 6

The surgical device of Examples 4 or 5, wherein the second advancingsystem further comprises a feeder bar extending distally from the cammember, and wherein the feeder bar is configured to move the clip in thefiring position into the receiver of the end effector when the cammember is moved from the proximal position to the intermediate position.

Example 7

The surgical device of Example 6, wherein the clip positioned in thereceiver is crimped by the first jaw and the second jaw when the cammember is moved from the intermediate position toward the distalposition by the second advancing system.

Example 8

A surgical device for clipping tissue. The surgical device comprises ahousing, a shaft extending from the housing and defining a shaft axis,and an end effector extending from the shaft. The end effector comprisesa first jaw, a second jaw, and a receiving portion at least partiallydefined between the first jaw and the. The first jaw and the second jaware movable relative to each other between an unclamped position and aclamped position. The surgical device further comprises a rotatable clipmagazine, a first feeding system, and a second feeding system. Therotatable clip magazine is configured to rotate about the shaft axisbetween a number of ejection positions. The clip magazine comprises aplurality of clips removable stored therein and one or more biasingmembers configured to bias a clip into a feeding position when the clipmagazine is in one of the number of ejection positions. The firstfeeding system comprises a first feeder member configured to translaterelative to the end effector. The first feeder member can advance a clipin the feeding position into a firing position located distal to thefeeding position. The second feeding system comprises a second feedermember configured to translate relative to the end effector. The secondfeeder member is configured to advance the clip in the firing positioninto the receiving portion of the end effector.

Example 9

The surgical device of Example 8, wherein the firing position is locatedin a clip track of the end effector.

Example 10

The surgical device of Examples 8 or 9, wherein the first feeding systemis driven by a first input and the second feeding system is driven by asecond input.

Example 11

The surgical device of Examples 8, 9, or 10, wherein the first jaw andthe second jaw are biased away from each other toward the unclampedposition, wherein the second feeding member comprises a cam member and afeeder bar extending distally from the cam member, wherein the cammember is positioned around the first jaw and the second jaw and isconfigured to translate relative to the end effector between a proximalposition, an intermediate position, and a distal position, and whereinthe intermediate position is located between the proximal position andthe distal position.

Example 12

The surgical device of Example 11, wherein the first jaw and the secondjaw are in the unclamped position when the cam member is in the proximalposition and the intermediate position, and wherein the first jaw andthe second jaw are moved toward the clamped position when the cam membermoves from the intermediate position to the distal position.

Example 13

The surgical device of Examples 11 or 12, wherein the feeder bar of thesecond feeder member is configured to move the clip in the firingposition into the receiving portion of the end effector when the cammember is moved from the proximal position to the intermediate position.

Example 14

The surgical device of Example 13, wherein the clip positioned in thereceiving portion is crimped by the first jaw and the second jaw whenthe cam member is moved from the intermediate position toward the distalposition.

Example 15

A surgical device for clipping tissue. The surgical device comprises ahousing, a shaft extending from the housing, and an end effectorextending from the shaft. The end effector comprises a first jaw, asecond jaw, and a receiver at least partially defined between the firstjaw and the second jaw. The first jaw and the second jaw are movablerelative to each other between an open position and a closed position.The surgical device further comprises a clip track, a clip magazineconfigured to store a plurality of clips, a first clip advancerconfigured to advance a clip from the clip magazine into a firingposition located in the clip track, and a second clip advancerconfigured to advance the clip from the firing position into thereceiver of the end effector. The second clip advancer is furtherconfigured to move the first jaw and the second jaw toward the closedposition.

Example 16

The surgical device of Example 15, wherein the first clip advancer isdriven by a first input and the second clip advancer is driven by asecond input.

Example 17

The surgical device of Examples 15 or 16, wherein the second clipadvancer comprises a jaw cam configured to move between a proximalposition, an intermediate position, and a distal position, and whereinthe intermediate position is located between the proximal position andthe distal position.

Example 18

The surgical device of Example 17, wherein the second clip advancerfurther comprises a feeder shoe extending from the jaw cam, and whereinfeeder shoe is configured to move a clip from the firing position intothe receiver of the end effector when the second clip advancer movesfrom the proximal position to the intermediate position.

Example 19

The surgical device of Example 18, wherein the jaw cam is configured tomove the first jaw and the second jaw toward the closed position tocrimp the clip positioned in the receiver of the end effector when thejaw cam moves from the intermediate position to the distal position.

Example 20

The surgical device of Examples 18 or 19, wherein, when the jaw cammoves from the intermediate position to the distal position, the feedershoe does not move.

Example Set 5 Example 1

A surgical device for clipping tissue. The surgical device comprises ahousing comprising an electric motor, a shaft extending from thehousing, and defining a central shaft axis, a clip magazine attachableto the shaft, and a clip crimping system. The clip magazine comprises aplurality of clips removably stored therein. The clip crimping systemcomprises a first jaw, a second jaw, a distal portion, a proximalconnection portion, and a clamp operably coupled with the electricmotor. The distal portion comprises a clip receiving chamber definedbetween the first jaw and the second jaw. The distal portion is offsetfrom the central shaft axis. The proximal connection portion connectsthe first jaw and the second jaw. The proximal connection portion ispositioned along the central shaft axis. The clamp is movable distallyby the electric motor to perform a crimping stroke and engage the firstjaw and the second jaw.

Example 2

The surgical device of Example 1, wherein the first jaw comprises afirst cantilever arm and the second jaw comprises a second cantileverarm.

Example 3

The surgical device of Example 2, wherein the proximal connectionportion integrally connects the first cantilever arm and the secondcantilever arm.

Example 4

The surgical device of Examples 1, 2, or 3, wherein the proximalconnection portion is positioned proximally with respect to the clipmagazine.

Example 5

The surgical device of Examples 2, 3, or 4, wherein the first cantileverarm and the second cantilever arm extend in a first plane proximal tothe clip magazine and a second plane distal to the clip magazine, andwherein the second plane is offset from the first plane.

Example 6

The surgical device of Example 5, wherein the proximal-most portion ofthe proximal connection portion extends out of the second plane.

Example 7

A surgical device for clipping tissue. The surgical device comprises ahousing comprising an electric motor, a shaft extending from the housingand defining a central shaft axis, a clip magazine attachable to theshaft, and a clip crimping system. The clip magazine comprises aplurality of clips removably stored therein. The clip crimping systemcomprises a first jaw arm, a second jaw arm, a clip receiving chamber, aproximal connection portion connecting the first jaw arm and the secondjaw arm, and a clamp drive operably coupled with the electric motor. Theclip receiving chamber is defined between a distal end of the first jawarm and a distal end of the second jaw arm. The clip receiving chamberis offset from the central shaft axis. The proximal connection portionextends along the central shaft axis. The clamp drive is movabledistally by the electric motor to perform a crimping stroke and engagethe first jaw arm and the second jaw arm.

Example 8

The surgical device of Example 7, wherein the first jaw arm comprises afirst cantilever arm and the second jaw arm comprises a secondcantilever arm.

Example 9

The surgical device of Example 8, wherein the proximal connectionportion integrally connects the first cantilever arm and the secondcantilever arm.

Example 10

The surgical device of Examples 7, 8, or 9, wherein the proximalconnection portion is positioned proximally with respect to the clipmagazine.

Example 11

The surgical device of Example 8, wherein the first cantilever arm andthe second cantilever arm extend in a first plane proximal to the clipmagazine and a second plane distal to the clip magazine, and wherein thesecond plane is offset from the first plane.

Example 12

The surgical device of Example 11, wherein the proximal-most portion ofthe proximal connection portion extends out of the second plane.

Example 13

A surgical device for clipping tissue. The surgical device comprises ashaft comprising a longitudinal shaft axis, a clip magazine attached tothe shaft, and a clip crimping system. The clip magazine comprises aplurality of clips removably stored therein. The clip crimping systemcomprises a first jaw arm, a second jaw arm, and a clip receivingchamber defined between a distal end of the first jaw arm and a distalend of the second jaw arm. The clip receiving chamber is offset from thecentral shaft axis. The clip crimping system further comprises aproximal connection portion connecting the first jaw arm and the secondjaw arm. The proximal connection portion extends along the longitudinalshaft axis. The clip crimping system further comprises a clamp drivecomprising a driver movable distally to engage the first jaw arm and thesecond jaw arm and move the first jaw arm and the second jaw arm towardone another.

Example 14

The surgical device of Example 13, wherein the first jaw arm comprises afirst cantilever arm and the second jaw arm comprises a secondcantilever arm.

Example 15

The surgical device of Example 14, wherein the proximal connectionportion integrally connects the first cantilever arm and the secondcantilever arm.

Example 16

The surgical device of Examples 13, 14, or 15, wherein the proximalconnection portion is positioned proximally with respect to the clipmagazine.

Example 17

The surgical device of Example 14, wherein the first cantilever arm andthe second cantilever arm extend in a first plane proximal to the clipmagazine and a second plane distal to the clip magazine, and wherein thesecond plane is offset from the first plane.

Example 18

The surgical device of Example 17, wherein the proximal-most portion ofthe proximal connection portion extends out of the second plane.

Example 19

The surgical device of Examples 17 or 18, wherein the proximal-mostportion of the proximal connection is folded out of the second plane andback toward the clip receiving chamber.

Example Set 6 Example 1

A surgical device for clipping tissue. The surgical device comprises ahousing comprising a motor configured to output rotary motions, a shaftextending from the housing, and a clip applier head extending from theshaft. The clip applier head comprises a clip magazine, an end effector,a jaw closure cam, and a clip advancing member. The clip magazinecomprises a plurality of clips. The end effector comprises a first jawand a second jaw movable relative to each other between an unclampedposition and a clamped position. The jaw closure cam is configured tomove the first jaw and the second jaw toward the clamped position. Theclip advancing member is operably attachable to the jaw closure cam. Theclip advancing member is configured to move a clip from the clipmagazine into a firing position. The jaw closure cam and the clipadvancing member are configured to move in opposite directions at thesame time.

Example 2

The surgical device of Example 1, further comprising a rotary drive,wherein the rotary drive is operably responsive to the rotary motions ofthe motor, and wherein the jaw closure cam is operably coupled to therotary drive.

Example 3

The surgical device of Example 2, wherein the jaw closure cam translatesin a distal direction to move the first jaw and the second jaw towardthe clamped position in response to the rotary drive rotating in a firstdirection.

Example 4

The surgical device of Example 3, wherein the clip advancing membertranslates in a proximal direction to move a clip toward the firingposition in response to the rotary drive rotating in a second direction.

Example 5

The surgical device of Example 4, wherein the first direction isopposite the second direction.

Example 6

The surgical device of Examples 1, 2, 3, 4, or 5, wherein the clipadvancing member comprises a biasing member configured to bias the clipadvancing member in a distal direction.

Example 7

The surgical device of Examples 1, 2, 3, 4, 5, or 6, further comprisinga latch operably attached to the jaw closure cam. The latch isconfigured to operably couple the jaw closure cam and the clip advancingmember. The surgical device further comprises a latch release configuredto operably decouple the clip advancing member from the jaw closure camwhen the clip advancing member is moved into the firing position.

Example 8

The surgical device of Examples 1, 2, 3, 4, 5, 6, or 7, wherein theshaft defines a shaft axis, and wherein the clip magazine is configuredto rotate about the shaft axis.

Example 9

A surgical device for clipping tissue. The surgical device comprises ahousing comprising a motor configured to output rotary motions, a shaftextending from the housing, a clip track comprising a plurality of clipsremovably stored therein, and an end effector extending from the shaft.The end effector comprises a first jaw, a second jaw, and a receivingportion at least partially defined between the first jaw and the secondjaw. The first jaw and the second jaw are movable relative to each otherbetween an unclamped position and a clamped position. The surgicaldevice further comprises a drive screw, a jaw cam member, and a clipadvancing member. The drive screw is operably responsive to the rotarymotions. The jaw cam member is operably engaged with the drive screw.The jaw cam member is configured to move the first jaw and the secondjaw toward the unclamped position in response to a rotation of the drivescrew in a first direction. The clip advancing member is operablyengaged with the drive screw. The clip advancing member is configured toadvance a clip from the clip track into the receiving portion of the endeffector in response to the rotation of the drive screw in the firstdirection.

Example 10

The surgical device of Example 9, wherein the drive screw comprises afirst thread pitch and a second thread pitch that is different than thefirst thread pitch, wherein the jaw cam member is threadably engagedwith the first thread pitch, and wherein the clip advancing member isthreadably engaged with the second thread pitch.

Example 11

The surgical device of Example 9, wherein the drive screw is configuredto translate the jaw cam member at a first rate in response to therotation of the drive screw, wherein the drive screw is furtherconfigured to translate the clip advancing member at a second rate inresponse to the rotation of the drive screw, and wherein the second rateand the first rate are different.

Example 12

The surgical device of Example 11, wherein the second rate is fasterthan the first rate.

Example 13

The surgical device of Examples 9, 10, 11, or 12, wherein the jaw cammember is configured to translate a first distance in response to therotation of the drive screw, wherein the clip advancing member isconfigured to translate a second distance in response to the rotation ofthe drive screw, and wherein the first distance and the second distanceare different.

Example 14

The surgical device of Example 13, wherein the second distance is longerthan the first distance.

Example 15

The surgical device of Example 9, wherein the jaw cam member moves thefirst jaw and the second jaw toward the clamped position in response toa rotation of the drive screw in a second direction, wherein the clipadvancing member moves toward a proximal position when the drive screwis rotated in the second direction, and wherein the second direction isopposite the first direction.

Example 16

The surgical device of Example 15, wherein the jaw cam member isconfigured to translate a first distance in response to the rotation ofthe drive screw in the second direction, wherein the clip advancingmember is configured to translate a second distance in response to therotation of the drive screw in the second direction, and wherein thefirst distance and the second distance are different.

Example 17

A surgical device for clipping tissue. The surgical device comprises ahousing comprising a motor configured to output rotary motions, a shaftextending from the housing, a clip magazine comprising a plurality ofclips, a clip applier head extending from the shaft, and a drive screwoperably responsive to the rotary motions. The drive screw is configuredto perform a first clip applier head action when the drive screw isrotated in a first direction, and perform a second clip applier headaction when the drive screw is rotated in a second direction oppositethe first direction.

Example 18

The surgical device of Example 17, wherein the clip applier headcomprises an end effector and a clip advancer. The end effectorcomprises a first jaw and a second jaw movable relative to each otherbetween an unclamped position and a clamped position. The clip advanceris movable between an unbiased position and a biased position.

Example 19

The surgical device of Example 18, wherein the first clip applier headaction comprises moving the first jaw and the second jaw toward theclamped position.

Example 20

The surgical device of Examples 18 or 19, wherein the second clipapplier head action comprises moving the clip advancer toward the biasedposition.

Example Set 7 Example 1

A surgical device for clipping tissue. The surgical device comprises ahousing comprising a motor, a shaft extending from the housing, a jawactuator operably responsive to the motor, a clip magazine comprising aplurality of clips, a reciprocating feeder drive operably responsive tothe motor, an end effector extending from the shaft. The end effectorcomprises a first jaw and a second jaw movable relative to each otherbetween a plurality of positions by way of the jaw actuator. Theplurality of positions comprises a ready-to-fire position where thefirst jaw and the second jaw are in a fully-open configuration, afully-deployed position where the first jaw and the second jaw are in afully-closed configuration, and a manipulation position intermediate theready-to-fire position and the fully-deployed position. The surgicaldevice further comprises a motor controller. The motor controller isconfigured to control the reciprocating feeder drive independent of thejaw actuator, advance a clip from the clip magazine into the endeffector by way of the feeder drive without actuating the jaw actuator,and actuate the jaw actuator without advancing a clip into the endeffector.

Example 2

The surgical device of Example 1, wherein the motor controller isfurther configured to control the motor based on a user input suppliedto the motor controller by the user of the surgical device.

Example 3

The surgical device of Example 2, wherein the user input comprises anactuator which, when actuated, moves the first jaw and the second jaw tothe fully-closed configuration without advancing a clip into the endeffector.

Example 4

The surgical device of Example 2, wherein the user input comprises anactuator which, when actuated, moves the first jaw and the second jaw toone of the plurality of positions without advancing a clip into the endeffector.

Example 5

The surgical device of Examples 1, 2, 3, or 4, further comprising aprocessor and a memory, wherein the motor controller is configured tocontrol the motor via the processor and the memory.

Example 6

The surgical device of Example 5, wherein the processor is configured toexecute a motor control algorithm stored in the memory to actuate thejaw actuator to move the first jaw and the second jaw between theplurality of positions.

Example 7

The surgical device of Examples 5 or 6, wherein the processor isconfigured to execute a motor control algorithm stored in the memory toactuate the reciprocating feeder drive independent of the jaw actuator.

Example 8

The surgical device of Examples 1, 2, 3, 4, 5, 6, or 7, wherein the clipmagazine is replaceable.

Example 9

A surgical device for clipping tissue. The surgical device comprises ahousing comprising a motor, a shaft extending from the housing, and ajaw actuator operably responsive to the motor. The jaw actuator isconfigured to translate between a proximal position and a distalposition. The surgical device further comprises a clip magazinecomprising a plurality of clips, a reciprocating feeder drive operablyresponsive to the motor, and an end effector extending from the shaft.The end effector comprises a first jaw and a second jaw movable relativeto each other between an open configuration and a closed configurationwhen the jaw actuator is moved between the proximal position and thedistal position. The surgical device further comprises a motorcontroller. The motor controller is configured to advance a clip fromthe clip magazine into the end effector by way of the feeder drive whileactuating the jaw actuator to move the first jaw and the second jawtoward the open configuration in response to a first user input in afiring operating mode. The motor controller is further configured toactuate the jaw actuator to move the first jaw and the second jaw towardthe closed configuration without advancing a clip into the end effectorin response to a second user input in a manipulation operating mode.

Example 10

The surgical device of Example 9, wherein the first user input and thesecond user input are different.

Example 11

The surgical device of Examples 9 or 10, wherein the first user inputcomprises an actuator which, when actuated by the user of the surgicaldevice, moves the first jaw and the second jaw toward the openconfiguration without advancing a clip into the end effector.

Example 12

The surgical device of Examples 9, 10, or 11, wherein the second userinput comprises an actuator which, when actuated by the user of thesurgical device, moves the first jaw and the second jaw toward theclosed configuration without advancing a clip into the end effector.

Example 13

The surgical device of Examples 9, 10, 11, or 12, further comprising aprocessor and a memory, wherein the motor controller is configured tocontrol the motor via the processor and the memory.

Example 14

The surgical device of Example 13, wherein the processor is configuredto execute a motor control algorithm stored in the memory to actuate thejaw actuator to move the first jaw and the second jaw between the openconfiguration and the closed configuration.

Example 15

The surgical device of Examples 13 or 14, wherein the processor isconfigured to execute a motor control algorithm stored in the memory toactuate the reciprocating feeder drive independent of the jaw actuator.

Example 16

The surgical device of Examples 9, 10, 11, 12, 13, 14, or 15, whereinthe clip magazine is replaceable.

Example 17

A surgical device for clipping tissue. The surgical device comprises aclip magazine comprising a plurality of clips, an end effector movablebetween an open position and a closed position, and a jaw actuatoroperably responsive to a first rotatable input. The jaw actuator isconfigured to move the end effector between the open position and theclosed position. The surgical device further comprises a reciprocatingfeeder drive and a controller. The reciprocating feeder drive isoperably responsive to a second rotatable input. The controller isconfigured to advance a clip from the clip magazine into the endeffector by way of the feeder drive when the end effector is in the openposition. The controller is further configured to actuate the jawactuator to move the end effector toward the closed position withoutadvancing a clip into the end effector.

Example 18

The surgical device of Example 17, wherein the controller is furtherconfigured to control the first rotatable input and the second rotatableinput based on a user input supplied to the controller by the user ofthe surgical device.

Example 19

The surgical device of Examples 17 or 18, wherein the clip magazine isreplaceable.

Example Set 8 Example 1

A surgical system for use in a surgical theater. The surgical systemcomprises a surgical tool and a surgical hub. The surgical toolcomprises a motor, a motor controller in signal communication with themotor, and an end effector configured to perform an end effectorfunction. The end effector is operably responsive to the motor. Thesurgical hub is in signal communication with the motor controller. Thesurgical hub is configured to detect a contextual cue within thesurgical theater. The motor controller is configured to adjust anoperating parameter of the motor based on the contextual cue detected bythe surgical hub.

Example 2

The surgical system of Example 1, wherein the contextual cue comprisespatient tissue properties.

Example 3

The surgical system of Examples 1 or 2, wherein the contextual cuecomprises pre-determined biometric data of a patient.

Example 4

The surgical system of Examples 1, 2, or 3, wherein the surgical toolfurther comprises a sensor configured to measure at least oneoperational parameter of the motor, wherein the sensor is in signalcommunication with the surgical hub.

Example 5

The surgical system of Examples 1, 2, 3, or 4, wherein the contextualcue comprises the at least one operational parameter measured by thesensor.

Example 6

The surgical system of Examples 3, 4, or 5, wherein the at least oneoperational parameter comprises the speed of the motor.

Example 7

The surgical system of Examples 3, 4, or 5, wherein the at least oneoperational parameter comprises the current draw of the motor.

Example 8

The surgical system of Examples 3, 4, or 5, wherein the at least oneoperational parameter comprises the torque output of the motor.

Example 9

The surgical system of Examples 1, 2, 3, 4, 5, 6, 7, or 8, wherein thesurgical system is further configured to initiate an inquiry to adatabase of the surgical hub, wherein the contextual cue results fromthe inquiry into the database.

Example 10

The surgical system of Examples 1, 2, 3, 4, 5, 6, 7, 8, or 9, whereinthe end effector function comprises grasping tissue between a first jawand a second jaw of the end effector, wherein the motor controller isconfigured to detect a current spike in the motor when the first jaw andthe second jaw grasp abnormal tissue, and wherein the contextual cuedetected by the surgical hub comprises the current spike detected by themotor controller.

Example 11

The surgical system of Examples 1, 2, 3, 4, 5, 6, 7, 8, or 9, whereinthe surgical tool comprises a clip applier, wherein the end effectorfunction comprises crimping a clip between a first jaw and a second jawof the clip applier, wherein the motor controller is configured todetect a current spike in the motor indicative of an improperly crimpedclip, and wherein the contextual cue detected by the surgical hubcomprises the current spike detected by the motor controller.

Example 12

A surgical system for use in a surgical theater. The surgical systemcomprises a clip applier and a surgical hub. The clip applier comprisesa motor, a motor controller in signal communication with the motor, acrimping drive operably responsive to the motor, and an end effector.The end effector comprises a first jaw and a second jaw movable relativeto each other from an open position toward a closed position in responseto a translation of the crimping drive during a crimping stroke. Thesurgical hub is in signal communication with the motor controller. Thesurgical hub is configured to detect a contextual cue within thesurgical theater. The motor controller is configured to adjust thecrimping stroke of the crimping drive based on the contextual cuedetected by the surgical hub.

Example 13

The surgical system of Example 12, wherein the contextual cue comprisespatient tissue properties.

Example 14

The surgical system of Examples 12 or 13, wherein the contextual cuecomprises pre-determined biometric data of a patient.

Example 15

The surgical system of Examples 12, 13, or 14, wherein the clip applierfurther comprises a sensor configured to measure at least oneoperational parameter of the motor, wherein the sensor is in signalcommunication with the surgical hub.

Example 16

The surgical system of Example 15, wherein the contextual cue comprisesthe at least one operational parameter measured by the sensor.

Example 17

The surgical system of Examples 15 or 16, wherein the at least oneoperational parameter comprises the speed of the motor.

Example 18

The surgical system of Examples 15 or 16, wherein the at least oneoperational parameter comprises the current draw of the motor.

Example 19

The surgical system of Examples 12, 13, 14, 15, 16, 17, or 18, whereinthe surgical system is further configured to initiate an inquiry to adatabase of the surgical hub, wherein the contextual cue is the resultof the inquiry.

Example 20

A surgical system for use in a surgical theater. The surgical systemcomprises a surgical tool and a surgical hub. The surgical toolcomprises a motor configured to output a rotary motion, a motorcontroller configured to control the motor, and a distal head configuredto execute a distal head function. The distal head function is executedin response to the rotary motion of the motor. The surgical hub is insignal communication with the motor controller. The surgical hub isconfigured to detect a contextual cue within the surgical theater. Themotor controller is configured to adjust the rotary motion of the motorbased on the detected contextual cue.

The devices, systems, and methods disclosed in the Subject applicationcan be used with the devices, systems, and methods disclosed in U.S.Provisional Patent Application Ser. No. 62/659,900, entitled METHOD OFHUB COMMUNICATION, filed Apr. 19, 2018; U.S. Provisional PatentApplication Ser. No. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM,filed Dec. 28, 2017; U.S. Provisional Patent Application Ser. No.62/611,340, entitled CLOUD-BASED MEDICAL ANALYTICS, filed Dec. 28, 2017;and U.S. Provisional Patent Application Ser. No. 62/611,339, entitledROBOT ASSISTED SURGICAL PLATFORM, filed Dec. 28, 2017.

The devices, systems, and methods disclosed in the Subject applicationcan also be used with the devices, systems, and methods disclosed inU.S. patent application Ser. No. 15/908,021, entitled SURGICALINSTRUMENT WITH REMOTE RELEASE, filed Feb. 28, 2018; U.S. patentapplication Ser. No. 15/908,012, entitled SURGICAL INSTRUMENT HAVINGDUAL ROTATABLE MEMBERS TO EFFECT DIFFERENT TYPES OF END EFFECTORMOVEMENT, filed Feb. 28, 2018; U.S. patent application Ser. No.15/908,040, entitled SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELYACTUATING MULTIPLE END EFFECTOR FUNCTIONS, filed Feb. 28, 2018; U.S.patent application Ser. No. 15/908,057, entitled SURGICAL INSTRUMENTWITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END EFFECTOR FUNCTIONS,filed Feb. 28, 2018; U.S. patent application Ser. No. 15/908,058,entitled SURGICAL INSTRUMENT WITH MODULAR POWER SOURCES, filed Feb. 28,2018; and U.S. patent application Ser. No. 15/908,143, entitled SURGICALINSTRUMENT WITH SENSOR AND/OR CONTROL SYSTEMS, filed Feb. 28, 2018.

The surgical instrument systems described herein can be used inconnection with the deployment and deformation of staples. Variousembodiments are envisioned which deploy fasteners other than staples,such as clamps or tacks, for example. Moreover, various embodiments areenvisioned which utilize any suitable means for sealing tissue. Forinstance, an end effector in accordance with various embodiments cancomprise electrodes configured to heat and seal the tissue. Also, forinstance, an end effector in accordance with certain embodiments canapply vibrational energy to seal the tissue. In addition, variousembodiments are envisioned which utilize a suitable cutting means to cutthe tissue.

The entire disclosures of:

U.S. Pat. No. 8,075,571, entitled SURGICAL CLIP APPLIER METHODS, whichissued on Dec. 13, 2011;

U.S. Pat. No. 8,038,686, entitled CLIP APPLIER CONFIGURED TO PREVENTCLIP FALLOUT, which issued on Oct. 18, 2011;

U.S. Pat. No. 7,699,860, entitled SURGICAL CLIP, which issued on Apr.20, 2010;

U.S. patent application Ser. No. 11/013,924, entitled TROCAR SEALASSEMBLY, now U.S. Pat. No. 7,371,227;

U.S. patent application Ser. No. 11/162,991, entitled ELECTROACTIVEPOLYMER-BASED ARTICULATION MECHANISM FOR GRASPER, now U.S. Pat. No.7,862,579;

U.S. patent application Ser. No. 12/364,256, entitled SURGICALDISSECTOR, now U.S. Patent Application Publication No. 2010/0198248;

U.S. patent application Ser. No. 13/536,386, entitled EMPTY CLIPCARTRIDGE LOCKOUT, now U.S. Pat. No. 9,282,974;

U.S. patent application Ser. No. 13/832,786, entitled CIRCULAR NEEDLEAPPLIER WITH OFFSET NEEDLE AND CARRIER TRACKS, now U.S. Pat. No.9,398,905;

U.S. patent application Ser. No. 12/592,174, entitled APPARATUS ANDMETHOD FOR MINIMALLY INVASIVE SUTURING, now U.S. Pat. No. 8,123,764;

U.S. patent application Ser. No. 12/482,049, entitled ENDOSCOPICSTITCHING DEVICES, now U.S. Pat. No. 8,628,545;

U.S. patent application Ser. No. 13/118,241, entitled SURGICAL STAPLINGINSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, now U.S. Pat.No. 9,072,535;

U.S. patent application Ser. No. 11/343,803, entitled SURGICALINSTRUMENT HAVING RECORDING CAPABILITIES, now U.S. Pat. No. 7,845,537;

U.S. patent application Ser. No. 14/200,111, entitled CONTROL SYSTEMSFOR SURGICAL INSTRUMENTS, now U.S. Pat. No. 9,629,629;

U.S. patent application Ser. No. 14/248,590, entitled MOTOR DRIVENSURGICAL INSTRUMENTS WITH LOCKABLE DUAL DRIVE SHAFTS, now U.S. Pat. No.9,826,976;

U.S. patent application Ser. No. 14/813,242, entitled SURGICALINSTRUMENT COMPRISING SYSTEMS FOR ASSURING THE PROPER SEQUENTIALOPERATION OF THE SURGICAL INSTRUMENT, now U.S. Patent ApplicationPublication No. 2017/0027571;

U.S. patent application Ser. No. 14/248,587, entitled POWERED SURGICALSTAPLER, now U.S. Pat. No. 9,867,612;

U.S. patent application Ser. No. 12/945,748, entitled SURGICAL TOOL WITHA TWO DEGREE OF FREEDOM WRIST, now U.S. Pat. No. 8,852,174;

U.S. patent application Ser. No. 13/297,158, entitled METHOD FORPASSIVELY DECOUPLING TORQUE APPLIED BY A REMOTE ACTUATOR INTO ANINDEPENDENTLY ROTATING MEMBER, now U.S. Pat. No. 9,095,362;

International Application No. PCT/US2015/023636, entitled SURGICALINSTRUMENT WITH SHIFTABLE TRANSMISSION, now International PatentPublication No. WO 2015/153642 A1;

International Application No. PCT/US2015/051837, entitled HANDHELDELECTROMECHANICAL SURGICAL SYSTEM, now International Patent PublicationNo. WO 2016/057225 A1;

U.S. patent application Ser. No. 14/657,876, entitled SURGICAL GENERATORFOR ULTRASONIC AND ELECTROSURGICAL DEVICES, U.S. Patent ApplicationPublication No. 2015/0182277;

U.S. patent application Ser. No. 15/382,515, entitled MODULAR BATTERYPOWERED HANDHELD SURGICAL INSTRUMENT AND METHODS THEREFOR, U.S. PatentApplication Publication No. 2017/0202605;

U.S. patent application Ser. No. 14/683,358, entitled SURGICAL GENERATORSYSTEMS AND RELATED METHODS, U.S. Patent Application Publication No.2016/0296271;

U.S. patent application Ser. No. 14/149,294, entitled HARVESTING ENERGYFROM A SURGICAL GENERATOR, U.S. Pat. No. 9,795,436;

U.S. patent application Ser. No. 15/265,293, entitled TECHNIQUES FORCIRCUIT TOPOLOGIES FOR COMBINED GENERATOR, U.S. Patent ApplicationPublication No. 2017/0086910; and

U.S. patent application Ser. No. 15/265,279, entitled TECHNIQUES FOROPERATING GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMSAND SURGICAL INSTRUMENTS, U.S. Patent Application Publication No.2017/0086914, are hereby incorporated by reference herein.

Although various devices have been described herein in connection withcertain embodiments, modifications and variations to those embodimentsmay be implemented. Particular features, structures, or characteristicsmay be combined in any suitable manner in one or more embodiments. Thus,the particular features, structures, or characteristics illustrated ordescribed in connection with one embodiment may be combined in whole orin part, with the features, structures or characteristics of one oremore other embodiments without limitation. Also, where materials aredisclosed for certain components, other materials may be used.Furthermore, according to various embodiments, a single component may bereplaced by multiple components, and multiple components may be replacedby a single component, to perform a given function or functions. Theforegoing description and following claims are intended to cover allsuch modification and variations.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, a device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the stepsincluding, but not limited to, the disassembly of the device, followedby cleaning or replacement of particular pieces of the device, andsubsequent reassembly of the device. In particular, a reconditioningfacility and/or surgical team can disassemble a device and, aftercleaning and/or replacing particular parts of the device, the device canbe reassembled for subsequent use. Those skilled in the art willappreciate that reconditioning of a device can utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

The devices disclosed herein may be processed before surgery. First, anew or used instrument may be obtained and, when necessary, cleaned. Theinstrument may then be sterilized. In one sterilization technique, theinstrument is placed in a closed and sealed container, such as a plasticor TYVEK bag. The container and instrument may then be placed in a fieldof radiation that can penetrate the container, such as gamma radiation,x-rays, and/or high-energy electrons. The radiation may kill bacteria onthe instrument and in the container. The sterilized instrument may thenbe stored in the sterile container. The sealed container may keep theinstrument sterile until it is opened in a medical facility. A devicemay also be sterilized using any other technique known in the art,including but not limited to beta radiation, gamma radiation, ethyleneoxide, plasma peroxide, and/or steam.

While this invention has been described as having exemplary designs, thepresent invention may be further modified within the spirit and scope ofthe disclosure. This application is therefore intended to cover anyvariations, uses, or adaptations of the invention using its generalprinciples.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdo not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

What is claimed is:
 1. A surgical system for use in a surgical theater,comprising: a surgical tool, comprising: a motor; a motor controller insignal communication with said motor; and an end effector configured toperform an end effector function, wherein said end effector is operablyresponsive to said motor; and a surgical hub in signal communicationwith said motor controller, wherein said surgical hub is configured todetermine a patient condition based on a detected contextual cue withinthe surgical theater, wherein said contextual cue comprises biometricdata of a patient, wherein said motor controller is configured to adjustan operating parameter of said motor based on said patient conditiondetermined by said surgical hub.
 2. The surgical system of claim 1,wherein said contextual cue comprises patient tissue properties.
 3. Thesurgical system of claim 1, wherein said biometric data of the patientis predetermined and stored in a surgical hub database.
 4. The surgicalsystem of claim 1, wherein said surgical tool further comprises a sensorconfigured to measure at least one operational parameter of said motor,and wherein said sensor is in signal communication with said surgicalhub.
 5. The surgical system of claim 4, wherein said contextual cuecomprises said at least one operational parameter measured by saidsensor.
 6. The surgical system of claim 5, wherein said at least oneoperational parameter comprises a speed of said motor.
 7. The surgicalsystem of claim 5, wherein said at least one operational parametercomprises a current draw of said motor.
 8. The surgical system of claim5, wherein said at least one operational parameter comprises a torqueoutput of said motor.
 9. The surgical system of claim 1, wherein saidsurgical system is further configured to initiate an inquiry to adatabase of said surgical hub, and wherein said contextual cue resultsfrom said inquiry to said database.
 10. The surgical system of claim 1,wherein said end effector function comprises grasping tissue between afirst jaw and a second jaw of said end effector, wherein said motorcontroller is configured to detect a current spike in said motor whensaid first jaw and said second jaw grasp abnormal tissue, and whereinsaid contextual cue detected by said surgical hub comprises said currentspike detected by said motor controller.
 11. The surgical system ofclaim 1, wherein said surgical tool comprises a clip applier, whereinsaid end effector function comprises crimping a clip between a first jawand a second jaw of said clip applier, wherein said motor controller isconfigured to detect a current spike in said motor indicative of animproperly crimped clip, and wherein said contextual cue detected bysaid surgical hub comprises said current spike detected by said motorcontroller.
 12. A surgical system for use in a surgical theater,comprising: a clip applier, comprising: a motor; a motor controller insignal communication with said motor; a crimping drive operablyresponsive to said motor; and an end effector, comprising: a first jaw;and a second jaw, wherein said first jaw and said second jaw are movablerelative to each other from an open position toward a closed position inresponse to a translation of said crimping drive during a crimpingstroke; and a surgical hub in signal communication with said motorcontroller, wherein said surgical hub is configured to determine apatient condition based on a detected contextual cue within the surgicaltheater, wherein said contextual cue comprises biometric data of apatient, wherein said motor controller is configured to adjust saidcrimping stroke of said crimping drive based on said patient conditiondetermined by said surgical hub.
 13. The surgical system of claim 12,wherein said contextual cue comprises patient tissue properties.
 14. Thesurgical system of claim 12, wherein said biometric data of the patientis predetermined and stored in a surgical hub database.
 15. The surgicalsystem of claim 12, wherein said clip applier further comprises a sensorconfigured to measure at least one operational parameter of said motor,wherein said sensor is in signal communication with said surgical hub.16. The surgical system of claim 15, wherein said contextual cuecomprises said at least one operational parameter measured by saidsensor.
 17. The surgical system of claim 16, wherein said at least oneoperational parameter comprises a speed of said motor.
 18. The surgicalsystem of claim 16, wherein said at least one operational parametercomprises a current draw of said motor.
 19. The surgical system of claim12, wherein said surgical system is further configured to initiate aninquiry to a database of said surgical hub, wherein said contextual cueis the result of said inquiry.
 20. A surgical system for use in asurgical theater, comprising: a surgical tool, comprising: a motorconfigured to output a rotary motion; a motor controller configured tocontrol said motor; and a distal head configured to execute a distalhead function, wherein said distal head function is executed in responseto said rotary motion of said motor; and a surgical hub in signalcommunication with said motor controller, wherein said surgical hub isconfigured to determine a patient condition based on a detectedcontextual cue within the surgical theater, wherein said contextual cuecomprises biometric data of a patient, wherein said motor controller isconfigured to adjust said rotary motion of said motor based on saiddetermined patient condition.
 21. A surgical system for use in asurgical theater, comprising: a surgical tool, comprising: a motor; andan end effector configured to be operably responsive to said motor; asensing tool configured to detect a contextual cue independent of saidsurgical tool; and a surgical hub in signal communication with saidsurgical tool and said sensing tool, wherein said surgical hub isconfigured to determine a patient condition based on said detectedcontextual cue, wherein said surgical hub is configured to adjust anoperating parameter of said motor based, at least in part, on saidpatient condition, wherein said detected contextual cue comprises atleast one of: a blood pressure, a cholesterol level, a co-morbidity, ahistory of smoking, a history of obesity, a family medical condition,bacterial activity, and polyarteritis nodosa, or combinations thereof.22. The surgical system of claim 21, wherein the sensing tool is acamera.
 23. The surgical system of claim 21, wherein the patientcondition comprises at least one of: a potential for atherosclerosis, ananeurysm, weakened artery wall, a presence of a clip, a presence of astaple, and a presence of an artificial object captured between jaws ofthe end effector, or combinations thereof.